CAJ | 학술논문

目的探讨应用桡动脉鼻烟窝穿支皮瓣与手指侧方顺行岛状皮瓣瓦合修复拇指旋转撕脱离断后大面积套状皮肤缺损的临床疗效.方法 2010年6月至2013年5月,应用桡动脉鼻烟窝穿支皮瓣与手指侧方顺行岛状皮瓣瓦合修复拇指旋转撕脱离断后大面积套状皮肤缺损10例,皮肤缺损面积6.0 cm× 3.0 cm～10.0 cm× 8.0 cm,根据桡动脉鼻烟窝穿支及手指指固有神经血管解剖特点,于前臂远端及手指侧方设计皮瓣,皮瓣内含桡动脉鼻烟窝穿支、桡神经浅支及指固有神经血管.结果所有皮瓣和移植皮片全部存活.随访6个月至2年,20块皮瓣感觉恢复情况:2块S1,4块S2,8块S3,6块S4.桡动脉鼻烟窝穿支皮瓣静态两点分辨觉为5～ 10 mm,手指侧方顺行岛状皮瓣静态两点分辨觉为3～8mm,皮瓣质地柔软、耐磨,手部功能及外形恢复较好,拇指指腹感觉功能恢复良好.按照中华医学会手外科学会手指再造功能评定试用标准综合评价:修复手指功能优7例,良2例,可1例;优良率90.0％.结论桡动脉鼻烟窝穿支皮瓣与手指侧方顺行岛状皮瓣血供安全、可靠,是修复拇指旋转撕脱离断后大面积套状皮肤缺损的理想皮瓣,不需吻合血管,皮瓣感觉恢复良好,是一种简单实用的手术方法.
목적 탐토응용뇨동맥비연와천지피판여수지측방순행도상피판와합수복무지선전시탈리단후대면적투상피부결손적림상료효.방법 2010년6월지2013년5월,응용뇨동맥비연와천지피판여수지측방순행도상피판와합수복무지선전시탈리단후대면적투상피부결손10례,피부결손면적6.0 cm× 3.0 cm～10.0 cm× 8.0 cm,근거뇨동맥비연와천지급수지지고유신경혈관해부특점,우전비원단급수지측방설계피판,피판내함뇨동맥비연와천지、뇨신경천지급지고유신경혈관.결과 소유피판화이식피편전부존활.수방6개월지2년,20괴피판감각회복정황:2괴S1,4괴S2,8괴S3,6괴S4.뇨동맥비연와천지피판정태량점분변각위5～ 10 mm,수지측방순행도상피판정태량점분변각위3～8mm,피판질지유연、내마,수부공능급외형회복교호,무지지복감각공능회복량호.안조중화의학회수외과학회수지재조공능평정시용표준종합평개:수복수지공능우7례,량2례,가1례;우량솔90.0％.결론 뇨동맥비연와천지피판여수지측방순행도상피판혈공안전、가고,시수복무지선전시탈리단후대면적투상피부결손적이상피판,불수문합혈관,피판감각회복량호,시일충간단실용적수술방법.
Objective To investigate the clinical outcomes of applying snuffbox radial artery perforator flap combined with lateral finger island flap to repair a large area of skin defect after thumb rotation avulsion injury.Methods From June 2010 to May 2013,10 cases with skin defects following thumb rotation avulsion injury were treated with this combined flap.The size of the defects ranged from 6.0 cm × 3.0 cm to 10.0 cm × 8.0 cm.Based on the anatomy of the radial artery snuffbox perforator and the proper digital neurovascular bundle,the combined flaps were designed at the distal forearm and lateral aspect of the finger to include the radial artery snuffbox perforator,superficial radial nerve and the proper digital neurovascular bundle.Results All the flaps and skin grafts survived.All the cases were follow-up for 6 to 24 months.Sensory recovery of the skin flap reached S1 in 2 cases,S2 in 4 cases,S3 in 8 cases,and S4 in 6 cases.Two-point discrimination was 5 to 10 mm on the snuffbox radial artery perforator flaps,and 3 to 8 mm on the lateral finger island flaps.The color,texture and contour of the flaps were good.According to the functional evaluation criteria of the Hand Surgery Society of Chinese Medical Association,the reconstruction results were rated as excellent in 7 cases,good in 2 cases,fair in 1 case,with a satisfactory rate of 90.0％.Conclusion A snuffbox radial artery perforator flap combined with lateral finger island flap is ideal for repairing large skin defects resulted from thumb rotation avulsion injury.The flaps have reliable blood supply without the need to anastomose blood vessels,as well as sensory nerves that restore good flap sensation.The procedure is safe and simple.