CAJ | 학술논문

目的：探讨以尺动脉远端穿支为蒂、以其上行支和下行支为轴心血管的双叶游离皮瓣修复手指复杂创面的临床效果。方法对徐州仁慈医院手足显微外科2010年5月—2013年5月,采用以尺动脉远端穿支为蒂、以其上行支和下行支为轴心血管的双叶游离皮瓣修复11例手指复杂创面患者的临床资料进行回顾性分析。其中男7例,女4例；年龄19~43岁；机器挤压伤7例,撕脱伤3例,电锯伤1例；指脱套伤创面4例,相邻两指创面2例,一指两处创面5例；受伤至手术时间为2.5 h ~8 d；创面范围2.0 cm ×5.5 cm ~6.0 cm ×9.0 cm,均伴有深部指骨、肌腱等外露。术后随访检测手指总主动活动度、静态两点辨别觉和患者自我评价等评价手指运动、感觉功能。结果术后1例皮瓣远端部分坏死,经植皮后愈合；其余10例皮瓣全部成活。平均随访13.8个月,皮瓣质地、外形满意,感觉恢复,供区瘢痕不明显,总主动活动度 TAM 130°~265°(健侧255°~270°),静态两点辨别觉2-PD 6.0~10.5 mm(健侧3.5~7.0 mm)。 TAM 评价优4例,良5例,可2例；2-PD 评价优1例,中10例；患者自我评价好9例,中2例。结论尺动脉远端穿支双叶游离皮瓣修复手指创面具有功能、外观、感觉恢复满意的优点,对指脱套伤、一指两处创面、相邻两指创面等复杂创面是一种可行、有效的修复方案。
목적：탐토이척동맥원단천지위체、이기상행지화하행지위축심혈관적쌍협유리피판수복수지복잡창면적림상효과。방법대서주인자의원수족현미외과2010년5월—2013년5월,채용이척동맥원단천지위체、이기상행지화하행지위축심혈관적쌍협유리피판수복11례수지복잡창면환자적림상자료진행회고성분석。기중남7례,녀4례；년령19~43세；궤기제압상7례,시탈상3례,전거상1례；지탈투상창면4례,상린량지창면2례,일지량처창면5례；수상지수술시간위2.5 h ~8 d；창면범위2.0 cm ×5.5 cm ~6.0 cm ×9.0 cm,균반유심부지골、기건등외로。술후수방검측수지총주동활동도、정태량점변별각화환자자아평개등평개수지운동、감각공능。결과술후1례피판원단부분배사,경식피후유합；기여10례피판전부성활。평균수방13.8개월,피판질지、외형만의,감각회복,공구반흔불명현,총주동활동도 TAM 130°~265°(건측255°~270°),정태량점변별각2-PD 6.0~10.5 mm(건측3.5~7.0 mm)。 TAM 평개우4례,량5례,가2례；2-PD 평개우1례,중10례；환자자아평개호9례,중2례。결론척동맥원단천지쌍협유리피판수복수지창면구유공능、외관、감각회복만의적우점,대지탈투상、일지량처창면、상린량지창면등복잡창면시일충가행、유효적수복방안。
Objective To explore the surgical method of applying the bilobed free flaps pedicled with the supracarpal cutaneous branch of ulnar artery to repair digital defects and report the clinical outcomes. Methods From May 2010 to May 2013, the bilobed free flap pedicled with the supracarpal cutaneous branch of ulnar artery was transplanted to repair skin defect on fingers. Eleven patients suffering from traumatic digital defects with complicating tendon and phalanx exposure were retrospectively hospitalized for treament in Xuzhou Renci Hospital. There were 11 cases in this group, including 7 male and 4 female cases, age 19 - 43 years old. Seven cases of crush injury machine, avulsion in 3 cases, 1 case of electric saw injury. The time between injury and operation was 2. 5 hours - 8 days; wound ranged from 2. 0 cm × 5. 5 cm to 6. 0 cm × 9. 0 cm. Main outcome measures included patient′s self-assessed physical appearance, total active motion (TAM), and two-point discrimination (2-PD). Results The flaps survived and the wounds healed by primary intention in all patients except one who experienced partial flap necrosis of the distal margin and required skin grafting. All patients were followed up for a mean of 13. 8 months. The physical appearance and texture of the repaired fingers were assessed as good with minimal scarring. The TAM and 2-PD were 130° -265°(contralateral, 255° -270°) and 6.0 -10.5 mm (contralateral, 3.5 -7.0 mm), respectively. The hand health status was patient-rated as good. Conclusions The use of the bilobed free flaps pedicled with the supracarpal cutaneous branch of ulnar artery is a feasible, effective, and safe treatment alternative for repairing complex digital defects with favorable aesthetic and motor-sensory outcomes.