改良限流足背动脉化静脉皮瓣修复手部缺损的长期随访
Long-term follow-up of modified shunt-restricted instep arterialized venous flap for reconstruction of hand defects.
作者信息
Chen Wei, Jian Yang, Cheng Maolin, Guan Runxue, An Wenyu, Yang Chenglan, Zhou Jian, Li Shujun, Chang Shusen, Deng Chengliang, Nie Kaiyu, Wei Zairong
机构信息
Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
出版信息
Front Med (Lausanne). 2025 Aug 18;12:1662159. doi: 10.3389/fmed.2025.1662159. eCollection 2025.
BACKGROUND
Instep arterialized venous flaps (iAVF) are suitable for reconstructing soft tissue defects of the hand while concurrently fulfilling aesthetic requirements. However, iAVF still face challenges such as unstable survival rates and swelling. Thus, this study aimed to propose a new strategy for iAVF, namely a modified shunt-restricted iAVF, for the reconstruction of hand defects.
METHODS
This retrospective study included 16 patients who underwent reconstruction of hand defects using the modified iAVF approach. All flaps were designed with antegrade flow, and the direct communicating branches between the afferent and efferent veins of the flap were ligated by sutures. The donor site of the flap was repaired by tension-reduction suture or full-thickness skin graft. Patient satisfaction and the Michigan Hand Questionnaire (MHQ) were used to evaluate the reconstructive effect and feasibility of the technique.
RESULTS
The thickness of the flaps ranged between 1.6-3.0 mm, with an average thickness of 2.3 mm. The donor site was directly sutured in 2 cases and repaired by full-thickness skin graft in 14 cases. All flaps completely survived. The flap color was pale in 11 cases and transitioned to a ruddy color within 2-5 h post-operatively, with an average of 3.3 h. Moreover, 12 cases developed mild swelling within 2 weeks postoperatively, whilst 4 cases presented with sporadic blisters. The follow-up duration ranged between 2 and 4.83 years (mean 3.71 years). The color and texture of the flap were close to healthy skin, and joint function was satisfactorily recovered. The mean total MHQ score for the injured side was similar to that for the contralateral healthy side (99.40 ± 1.72 vs. 99.96 ± 0.15, = 0.068; 95% confidence interval: 0.0-0.38). No significant differences were noted in MHQ scales.
CONCLUSION
Modified iAVF represents an aesthetic and functional superthin flap, which is simple and reliable for hand defect reconstruction.
背景
足背动脉化静脉皮瓣（iAVF）适用于手部软组织缺损的修复，同时满足美学需求。然而，iAVF仍面临成活率不稳定和肿胀等挑战。因此，本研究旨在提出一种iAVF的新策略，即改良分流限制iAVF，用于手部缺损的修复。
方法
本回顾性研究纳入了16例行改良iAVF方法修复手部缺损的患者。所有皮瓣均设计为顺行血流，皮瓣的动静脉之间的直接交通支通过缝合结扎。皮瓣供区采用减张缝合或全厚皮片移植修复。采用患者满意度和密歇根手功能问卷（MHQ）评估该技术的修复效果和可行性。
结果
皮瓣厚度为1.6 - 3.0毫米，平均厚度为2.3毫米。2例供区直接缝合，14例采用全厚皮片移植修复。所有皮瓣均完全存活。11例皮瓣颜色苍白，术后2 - 5小时转为红润，平均3.3小时。此外，12例术后2周内出现轻度肿胀，4例出现散在水泡。随访时间为2至4.83年（平均3.71年）。皮瓣颜色和质地接近正常皮肤，关节功能恢复满意。伤侧的平均总MHQ评分与对侧健康侧相似（99.40 ± 1.72 vs. 99.96 ± 0.15，P = 0.068；95%置信区间：0.0 - 0.38）。MHQ各量表无显著差异。
结论
改良iAVF是一种美观且功能良好的超薄皮瓣，用于手部缺损修复简单可靠。
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