Wang H, Yang X X, Huo Y X, Qin H Y, Wang W, Wang B, Jiang W P
Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China.
College of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan 063210, China.
Zhonghua Shao Shang Za Zhi. 2021 Jul 20;37(7):635-639. doi: 10.3760/cma.j.cn501120-20200422-00234.
To investigate the clinical effects of ulnar artery perforator chain flaps in repairing wounds on distal forearm or wrist with vascular anastomosis. The retrospective observational study method was used. From March 2015 to July 2019, a total of 11 serious trauma patients on distal forearm or wrist with vascular injury were admitted to the Second Hospital of Tangshan, including 8 male patients and 3 female patients, aged from 25 to 62 years, with an average age of 45 years. Vascular anastomosis and tendon repair were performed in all patients, and fracture reduction and fixation were conducted in 9 patients, of which 8 patients underwent external fixation of radius. The residual wounds were located in palmar distal forearm in 5 patients, palmar wrist in 4 patients, dorsal distal forearm in 1 patient, and dorsal wrist in 1 patient, with wound sizes ranged from 4.5 cm×3.0 cm to 10.0 cm×6.0 cm after the last debridement. The wounds were repaired with ulnar artery perforator chain flaps, with the flap sizes ranged from 5.2 cm×3.5 cm to 11.0 cm×7.0 cm. The wound in flap donor site of 1 patient was sutured directly, the wounds in flap donor sites of the other 10 patients were repaired with free skin grafts from ipsilateral thigh after being sutured partially, and the sizes of free skin grafts ranged from 4.0 cm×2.0 cm to 8.5 cm×5.0 cm. The survivals of flaps, skin grafts, and injured limbs after operation were observed. The appearances of the flaps and donor sites of flaps were observed during follow-up. At the final follow-up, the static two-point discrimination distances of the flaps were measured, and the satisfaction degrees of patients for the appearances of injured limbs were evaluated based on Michigan Hand Function Questionnaire. All flaps, skin grafts, and injured limbs survived after operation, without wound infection and blister formation. All patients were followed up for 8 to 26 months, the appearances of the flaps were good and not bloated, with similar color, texture, and thickness to the surrounding skin. The donor sites of flaps repaired with skin grafts were smooth, with circle scar at the edges. At the final follow-up, the static two-point discrimination distances of the flaps was 10-15 mm; 7 patients were strongly satisfied with the appearances of the injured limbs, and the remaining 4 patients were satisfied with the appearances of flaps. The ulnar artery perforator chain flap has constant vascular anatomy and reliable blood supply, with simple operation, which provides a good treatment method for repairing wounds on distal forearm or wrist with vascular anastomosis. It is especially suitable for the patients with radius fracture fixed by external fixator.
探讨尺动脉穿支链式皮瓣吻合血管修复前臂远端或腕部创面的临床效果。采用回顾性观察研究方法。2015年3月至2019年7月，唐山市第二医院共收治11例前臂远端或腕部严重创伤伴血管损伤患者，其中男8例，女3例，年龄25～62岁，平均年龄45岁。所有患者均行血管吻合及肌腱修复，9例行骨折复位固定，其中8例行桡骨外固定。残余创面位于前臂远端掌侧5例，腕掌侧4例，前臂远端背侧1例，腕背侧1例，末次清创后创面大小为4.5 cm×3.0 cm至10.0 cm×6.0 cm。采用尺动脉穿支链式皮瓣修复创面，皮瓣大小为5.2 cm×3.5 cm至11.0 cm×7.0 cm。1例患者皮瓣供区创面直接缝合，其余10例患者皮瓣供区创面部分缝合后取自体同侧大腿游离皮片修复，游离皮片大小为4.0 cm×2.0 cm至8.5 cm×5.0 cm。观察术后皮瓣、皮片及伤肢成活情况。随访期间观察皮瓣及皮瓣供区外观。末次随访时测量皮瓣静态两点辨别距离，并根据密歇根手功能问卷评估患者对伤肢外观的满意度。术后所有皮瓣、皮片及伤肢均成活，无伤口感染及水泡形成。所有患者随访8～26个月，皮瓣外观良好，无臃肿，颜色、质地、厚度与周围皮肤相近。皮瓣供区采用皮片修复者创面平整，边缘呈环形瘢痕。末次随访时，皮瓣静态两点辨别距离为10～15 mm；7例患者对伤肢外观非常满意，其余4例患者对皮瓣外观满意。尺动脉穿支链式皮瓣血管解剖恒定，血供可靠，手术操作简单，为吻合血管修复前臂远端或腕部创面提供了一种良好的治疗方法。尤其适用于桡骨骨折行外固定架固定的患者。
