Zhang Xingqun, Yao Yi, Rao Lei, Qin Zhenbo, Zhang Longchun, Xu Yibo, Chen Ying, Yao Jianmin, Song Dajiang
Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China.
Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Apr 15;34(4):497-500. doi: 10.7507/1002-1892.201904072.
To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.
Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases).
All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily.
Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.
探讨游离带感觉肋间动脉穿支皮瓣在手软组织重建中的有效性。
2010年3月至2015年9月，采用游离带感觉肋间动脉穿支皮瓣修复19例手部软组织缺损患者，其中男16例，女3例，年龄18～53岁，平均35.2岁。缺损位于手背15例，手掌4例。致伤原因：交通事故伤8例，热压伤5例，绞榨伤4例，撕脱伤2例。均为手部全层皮肤软组织缺损，伴有指骨、肌腱、血管及神经外露。缺损面积为10.0 cm×7.0 cm至17.0 cm×8.0 cm。急诊手术12例，择期手术7例。皮瓣厚度为10～25 mm，皮瓣面积为10.0 cm×7.5 cm至17.0 cm×8.0 cm。皮瓣血管蒂与桡动脉鼻烟窝支吻合12例，与桡动脉主干吻合7例，并与伴行静脉吻合，皮瓣肋间神经皮支与前臂外侧皮神经吻合。供区直接缝合14例，中厚皮片移植修复5例。
所有皮瓣及皮片均成活，供区及受区伤口均一期愈合。19例患者均获随访，随访时间10～18个月，平均12.7个月。术后手部外观及功能恢复良好，皮瓣无臃肿。皮瓣两点辨别觉为7～11 mm，平均8.8 mm。供区直接缝合者仅遗留线状瘢痕。供区感觉功能无明显影响，手部功能恢复满意。
游离带感觉肋间动脉穿支皮瓣是修复手部软组织缺损的一种有价值且可靠的技术。
