Chen Jing, Chen Qingzhong, Li Shuang, Wang Yang, Wang Weifeng, Tan Jun
Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001, P.R.China.
Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Apr 15;33(4):475-478. doi: 10.7507/1002-1892.201811114.
To summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers.
Between January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 3.5 cm×2.5 cm to 10.5 cm×3.5 cm. All donor sites were directly sutured except that 1 case was recovered with free skin graft.
All flaps survived entirely except that 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm).
Modified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved by using this flap to repair soft tissue defect of finger.
总结改良动脉化静脉皮瓣修复手指软组织缺损的疗效。
2017年1月至2018年4月，治疗16例手指软组织缺损患者。男12例，女4例，平均年龄41岁（24 - 74岁）。1例因瘢痕挛缩切除所致，15例因机械绞榨伤所致。缺损位于拇指3例，示指5例，中指4例，环指2例，小指2例；位于手掌侧4例，背侧12例。缺损大小为3 cm×2 cm至10 cm×3 cm。所有皮瓣均取自同侧前臂掌侧。结扎两条静脉的远端。切除部分脂肪，并在显微镜下结扎两条静脉之间所有相连的微小分支，以实现彻底的动静脉分流限制。然后将皮瓣原位覆盖于受区，不进行翻转。皮瓣大小为3.5 cm×2.5 cm至10.5 cm×3.5 cm。除1例采用游离皮片移植修复供区外，其余供区均直接缝合。
除1例发生静脉危象外，所有皮瓣均完全成活。3例皮瓣出现轻至中度静脉淤血，未作任何处理，1周后皮瓣肿胀逐渐消退。供区皮片移植成活，所有切口均一期愈合。13例患者随访8 - 16个月（平均11个月）。皮瓣质地及外观满意。末次随访时，皮瓣Semmes - Weinstein（SW）单丝试验平均值为4.01 g（2.83 - 4.56 g）；皮瓣静态两点辨别觉平均值为12 mm（6 - 20 mm）。
彻底限制动静脉分流的改良动脉化静脉皮瓣可减少静脉皮瓣的淤血，提高成活率。采用该皮瓣修复手指软组织缺损可取得较好疗效。
