CAJ | 학술논문

目的探讨应用游离上臂内侧皮瓣急诊修复手指一侧指固有动脉、指神经缺损合并皮肤软组织缺损的手术方法及临床疗效.方法急诊应用游离上臂内侧皮瓣修复13例13指合并皮肤软组织、神经缺损的患者,缺损面积为4.5 cm×3.5 cm～2.0 cm× l.5 cm,以上臂内侧皮瓣内的轴心动脉及神经桥接修复指一侧固有动脉、神经的缺损,切取皮瓣的面积为5.0 cm×4.0 cm～2.5 cm× 2.0 cm;指神经缺损的长度最大为4.5 cm,最小为1.5 cm,平均3.0 cm;上臂内侧皮瓣供区直接拉拢缝合.结果 13例皮瓣及手指均存活良好,供受区创面Ⅰ期愈合.随访6个月至2年,损伤手指感觉和功能恢复良好,皮瓣外观和质地佳,患者对手指和皮瓣外形满意.术后随访指端两点分辨觉为6～ 12 mm,平均9mm;皮瓣的两点分辨觉为8～ 12 mm,平均10 mm.结论急诊应用上臂内侧游离皮瓣既可以桥接伤指神经又能够解决创面皮肤软组织的缺损问题,可以恢复手指良好的感觉和功能,是解决此类手指损伤的一种理想的方法.
목적 탐토응용유리상비내측피판급진수복수지일측지고유동맥、지신경결손합병피부연조직결손적수술방법급림상료효.방법 급진응용유리상비내측피판수복13례13지합병피부연조직、신경결손적환자,결손면적위4.5 cm×3.5 cm～2.0 cm× l.5 cm,이상비내측피판내적축심동맥급신경교접수복지일측고유동맥、신경적결손,절취피판적면적위5.0 cm×4.0 cm～2.5 cm× 2.0 cm;지신경결손적장도최대위4.5 cm,최소위1.5 cm,평균3.0 cm;상비내측피판공구직접랍롱봉합.결과 13례피판급수지균존활량호,공수구창면Ⅰ기유합.수방6개월지2년,손상수지감각화공능회복량호,피판외관화질지가,환자대수지화피판외형만의.술후수방지단량점분변각위6～ 12 mm,평균9mm;피판적량점분변각위8～ 12 mm,평균10 mm.결론 급진응용상비내측유리피판기가이교접상지신경우능구해결창면피부연조직적결손문제,가이회복수지량호적감각화공능,시해결차류수지손상적일충이상적방법.
Objective To investigate the surgical methods and clinical outcomes of free medial upper arm flap for emergent repair of fingers with unilateral defects of the digital artery, nerve, and soft tissue.Methods The medial upper arm flap was used for emergent repair of 13 fingers of 13 cases that had severe artery, nerve and skin defects.The maximum and minimum area of defect was 4.5 cm × 3.5 cm and 2.0 cm × 1.5 cm, respectively.The length of nerve defects ranged from 1.5 cm to 4.5 cm with an average of 3.0 cm.The axial vessel and nerve in the medial upper arm superior ulnar collateral artery flap were inset to bridge the digital artery and nerve.The flap, measuring from 2.5 cm × 2.0 cm to 5.0 cm × 4.0 cm, was used to cover the soft tissue defect.The donor site was closed directly.Results All of the 13 flaps and fingers survived completely.The donor site wounds achieved primary healing.Postoperative follow-up time ranged from 6 months to 2 years.The function, texture, and appearance of all the flaps and fingers were satisfactory.Postoperatively,two-point discrimination of the fingertip was 6 to 12 mm, mean 9 mm.Two-point discrimination of the flap was 8 to 12 mm, mean 10 mm.Conclsion Free medial upper arm superior ulnar collateral artery flap can repair the nerve and skin defects of the severed fingers, with satisfactory restoration of sensation and function.It is an ideal procedure for salvaging fingers with tmilateral digital artery, nerve, and soft tissue defects.