Li Muwei, Liang Wenxian, Luo Zhaohui, Huang Shaogeng, Ma Lifeng, Yang Yanjun, Zhang Ziqing
Department of Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong, 518116, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Jun 8;30(6):732-735. doi: 10.7507/1002-1892.20160149.
To discuss the effectiveness of free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers.
Between May 2010 and September 2015, 28 patients with dorsal soft tissue defect of fingers were treated, including 17 males and 11 females with an average age of 23.8 years (range, 15-55 years). The reasons of injuries were machine twist (15 cases), heavy pound (4 cases), the sharp cut (5 cases), and hot crush (4 cases). The time from injury to admission was 30 minutes to 12 hours (mean, 1.5 hours). The involved fingers included thumb (3 cases), index finger (8 cases), middle finger (6 cases), ring finger (6 cases), and little finger (5 cases). The area of soft?tissue?defects ranged from 2.0 cm×1.5 cm to 3.5 cm×2.5 cm, and the area of free toe fibular-dorsal artery flap ranged from 2.8 cm×1.7 cm to 3.8 cm×2.8 cm. The blood supply of the flaps were reconstructed by anastomosing the toe fibular-dorsal artery, vein, and nerve to the dorsal digital artery, vein, and nerve, respectively. The donor site was repaired by free skin graft.
The operation time was 1.5-5.5 hours (mean, 2.5 hours); the blood loss during operation was 10-50 mL (mean, 30 mL). Vessel?crisis?occurred?in?1 case, and the flap survived after symptomatic treatment. The other flaps survived and the wounds healed with stage I; the skin grafts at donor site survived and the incisions healed with stage Ⅰ. Twenty-eight cases were followed up 6-24 months (mean, 8 months). The appearance of flaps was good, and two-point discrimination was 3.5-12.0 mm (mean, 5.3 mm) at 6 months after operation. The fingers function of grab and pinch recovered. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 20 cases and good in 8 cases, with an excellent and good rate of 100% at 6 months after operation. The donor sites of toe were smooth and had no depression. The patients had normal gait.
Free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers can obtain satisfactory effectiveness in appearance and function of fingers, and has the advantages of modified repair and less injury at donor site.
探讨吻合指背动脉的游离足趾腓侧趾背动脉皮瓣修复手指背侧软组织缺损的疗效。
2010年5月至2015年9月，收治28例手指背侧软组织缺损患者，其中男17例，女11例，平均年龄23.8岁（15～55岁）。致伤原因：机器绞伤15例，重物砸伤4例，锐器切割伤5例，热压伤4例。受伤至入院时间为30分钟至12小时（平均1.5小时）。患指包括拇指3例，示指8例，中指6例，环指6例，小指5例。软组织缺损面积为2.0 cm×1.5 cm至3.5 cm×2.5 cm，游离足趾腓侧趾背动脉皮瓣面积为2.8 cm×1.7 cm至3.8 cm×2.8 cm。将足趾腓侧趾背动脉、静脉、神经分别与指背动脉、静脉、神经吻合重建皮瓣血运。供区采用游离植皮修复。
手术时间为1.5～5.5小时（平均2.5小时）；术中出血量为10～50 ml（平均30 ml）。1例发生血管危象，经对症处理后皮瓣成活。其余皮瓣均成活，创面Ⅰ期愈合；供区植皮成活，切口Ⅰ期愈合。28例随访6～24个月（平均8个月）。皮瓣外观良好，术后6个月两点辨别觉为3.5～12.0 mm（平均5.3 mm）。手指抓捏功能恢复。按中华医学会手外科学分会手功能评定标准，优20例，良8例，术后6个月优良率达100%。足趾供区平整，无凹陷。患者步态正常。
吻合指背动脉的游离足趾腓侧趾背动脉皮瓣修复手指背侧软组织缺损，在手指外观及功能方面可获得满意疗效，且具有修复方式改良、供区损伤小等优点。
