Wang Hui, Wang Haifeng, Qin Haoyu, Hao Ruizheng, Ma Tiepeng, Liu Ying, Wang Bin
Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China.
Department of Functional Examination, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Aug 15;38(8):1016-1021. doi: 10.7507/1002-1892.202404006.
To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds.
The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm.
All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively.
The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.
探讨基于指动脉（DA）和掌背动脉（DMA）的穿支推进皮瓣（PPF）修复手部创面的有效性。
回顾性分析2018年1月至2023年3月间45例手部创面患者的临床资料。其中男性27例，女性18例，平均年龄41.2岁（范围14 - 72岁）。致伤原因包括扭挫伤15例、挤压伤19例、切割伤11例。受伤部位包括手指32例、手背10例、手掌3例，均有肌腱、关节及骨质外露。受伤至手术时间为2 - 8小时（平均4.3小时）。清创后创面大小为1.8 cm×1.0 cm至5.0 cm×3.5 cm。采用基于DA的PPF修复28例，基于DMA的PPF修复17例。皮瓣大小为2.5 cm×1.1 cm至8.5 cm×4.0 cm。14例患者供区创面直接缝合，其余31例患者供区创面采用前臂近端内侧全厚皮片游离移植修复。
术后所有皮瓣均存活。2例基于DA的PPF和1例基于DMA的PPF远端出现部分水疱，换药后愈合。供区切口一期愈合，植皮存活。所有患者随访10 - 33个月，平均15.4个月。末次随访时，基于DA和DMA的PPF静态两点辨别觉分别为4 - 14 mm和8 - 20 mm，平均分别为8.1 mm和13.3 mm。根据密歇根手功能结果问卷，20例患者对基于DA的PPF外观非常满意，8例满意；8例患者对基于DMA的PPF外观非常满意，9例满意。基于温哥华瘢痕量表（VSS），基于DA和DMA的PPF供区外观评分分别为2 - 7分和4 - 9分，平均分别为4.2分和6.1分。
两种PPF血供可靠，切取方便，为手部中小面积创面的急诊修复提供了一种良好的方法。
