Zhang Y J, Ju J H, Zhao Q, Wang B Y, Cheng H Y, Wang G Y, Hou R X
Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2022 Oct 20;38(10):959-963. doi: 10.3760/cma.j.cn501120-20210707-00238.
To explore the clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects. A retrospective observational study was conducted. From August 2016 to August 2019, 7 patients with thumb or finger defects caused by mechanical damage who met the inclusion criteria were admitted to Ruihua Affiliated Hospital of Soochow University, including 6 males and 1 female, aged 46 to 58 years. Their length of fingers was repaired with iliac bone, with length of 2.0 to 3.0 cm. After the bone graft, the skin defect area of the affected finger ranged from 2.8 cm×2.2 cm to 6.0 cm×3.2 cm. Then the free proximal ulnar artery perforator flap with area of 3.0 cm×2.4 cm to 6.5 cm×3.5 cm was used to cover the wounds. The wounds in donor sites of iliac crest and flap were directly sutured. The survival of flap in one week post surgery and the donor site wound healing in 2 weeks post surgery were observed, respectively. During the follow-up, the appearance and sensory function of the affected finger, bone healing, and scar hypertrophy of wound in the donor site were observed and evaluated. At the last follow-up, the functional recovery of the affected finger was evaluated with trial standard for the evaluation of functions of the upper limbs of the Hand Surgery Society of Chinese Medical Association. In one week post surgery, all the flaps survived. In 2 weeks post surgery, the iliac bone and the wounds in forearm donor site healed. During the follow-up of 5 to 13 months, the flap was good in appearance, without obvious pigmentation; the sensory recovery reached level S in 5 patients and S in 2 patients; all the grafted iliac bones were bony union without obvious resorption; the wounds in donor site healed well, with only mild scar formation. At the last follow-up, the shape of the reconstructed finger was close to the healthy finger, and the functional evaluation results were excellent in 3 cases and good in 4 cases. The use of proximal ulnar artery perforator flap combined with iliac bone graft to reconstruct subtotal thumb or finger can partially restore part of the appearance and function, with less damage to the donor site. It is a good choice for patients who have low expectations of appearance and function for the reconstructed finger.
探讨尺动脉近端穿支皮瓣联合髂骨移植修复拇指或手指部分缺损的临床效果。进行一项回顾性观察研究。2016年8月至2019年8月，苏州大学附属瑞华医院收治7例符合纳入标准的因机械损伤导致拇指或手指缺损的患者，其中男6例，女1例，年龄46～58岁。手指长度用髂骨修复，长度为2.0～3.0 cm。植骨后，患指皮肤缺损面积为2.8 cm×2.2 cm至6.0 cm×3.2 cm。然后采用面积为3.0 cm×2.4 cm至6.5 cm×3.5 cm的游离尺动脉近端穿支皮瓣覆盖创面。髂嵴供区和皮瓣供区创面直接缝合。分别观察术后1周皮瓣存活情况及术后2周供区创面愈合情况。随访期间，观察并评估患指外观、感觉功能、骨愈合情况及供区创面瘢痕增生情况。末次随访时，按照中华医学会手外科学会上肢功能评定试用标准对患指功能恢复情况进行评定。术后1周，所有皮瓣均存活。术后2周，髂骨及前臂供区创面愈合。随访5～13个月，皮瓣外观良好，无明显色素沉着；5例患者感觉恢复达S级，2例患者达S级；所有移植髂骨均骨性愈合，无明显吸收；供区创面愈合良好，仅形成轻度瘢痕。末次随访时，再造指外形接近健指，功能评定结果：优3例，良4例。尺动脉近端穿支皮瓣联合髂骨移植修复拇指或手指部分缺损可部分恢复部分外观和功能，对供区损伤较小。对于对手指再造外观和功能期望较低的患者是一种较好的选择。
