岛状皮神经营养血管皮瓣在四肢远端创面修复中的应用

Application of neurocutaneous vascular flap in repair of wounds in distal limbs

关键词:  皮神经营养血管皮瓣  创伤  修复

Key words:  neurocutaneous vascular flaps  wound  repair

摘要:

目的探讨利用岛状皮神经营养血管皮瓣修复四肢远端创面的临床效果。方法 利用岛状皮神经营养血管皮瓣修复四肢远端创伤38例,其中低旋转点腓肠神经营养血管皮瓣14例,隐神经营养血管皮瓣5例,足背皮神经营养血管皮瓣3例,掌背皮神经营养血管皮瓣8例。前臂内侧皮神经营养血管皮瓣4例,前臂后侧皮神经营养血管皮瓣4例。术前运用彩色超声血流成像技术探查供血穿支位置、管径、血流及伴行静脉,评价血管质量,为皮瓣设计提供参考。结果 34例皮瓣完全成活。1例腓肠神经营养血管皮瓣远端1cm坏死,1例隐神经营养血管皮瓣中末1/3坏死,创面愈合。2例掌背皮神经营养血管皮瓣远端局部坏死,换药后创面愈合。结论皮神经营养血管皮瓣修复手足远端创伤,成活率较高,操作简单,可较好地满足手足形态恢复和功能重建的需要。

Abstract:

Objective To assess the clinical application of neurocutaneous vascular flap in the repair of wounds in the distal limbs. Methods Neurocutaneous vascular flaps were used to repair the wounds on hands and feet in 38 cases totally, including 14 lower rotating point sural neurofasciocutaneous flaps; 5 saphenous neurocutaneous flaps; 3 dorsal neurocutaneous flap; 8 dorsal metacarpal neurocu-taneous vascular flaps; 4 forearm neurocutaneous vascular flaps on the inner side; 4 forearm neurocutaneous vascular flaps on the back side. The color Doppler flow imaging technique was used to search positions of blood supply of perforator, caliber, blood flow and accompanying vein before operation for evaluating quality of blood vessels and providing references of layout of flaps. ResultsThe flaps were survived in 34 cases; the necrosis occurred in 1 case of lower rotating point sural neurofasciocutaneous flaps on 1cm far-end of foot, 1 case of middle-and-far end of sural neurofasciocutaneous flaps, and 2 cases of partial dorsal metacarpal neurocutaneous vascular flaps. However, all of wounds were healed after dressing changing. Conclusion The wounds in distant limbs can be repaired by neurocutaneous vascular flaps with a higher survival rate, easier surgical procedure, and satisfactory function and shape recovery.