袁伟伟 匡斌 赵成利

DOI：10.3760/cma.j.issn.1671-0282.2014.08.018

作者单位：510080 广州，广州广东省人民医院 广东省医学科学院整形周围血管外科

通信作者：袁伟伟，Email：yww3229@hotmail.com

【摘要】目的 总结前臂逆行骨间背动脉皮瓣修复手掌及虎口皮肤软组织缺损的方法，并提出手术要点。

访法 2008-2013年，采用骨间背动脉皮瓣逆行转移修复手掌部、虎口处皮肤软组织缺损20例。骨间背侧动脉在前臂深浅两层伸肌间下行，发出5～13条皮支营养前臂背侧皮肤。该皮瓣切取范围大，血运好，成活率高。

结果 本组应用20例骨间背侧动脉皮瓣修复手掌、虎口处皮肤软组织缺损，皮瓣全部成活，均收到良好效果。

结论 该皮瓣保留上肢血供的二条主要动脉，皮瓣的血供丰富，根据皮瓣的切取范围大小，供区可直接缝合或游离植皮，术后供区的外观和功能影响小。

【关键词】骨间背侧动脉；皮瓣 ；修复；逆行；手外伤；软组织；组织缺损

Forearm skin flap with dorsal interosseous artery transplanted in reversal position to repair the skin and soft tissue defect of palm and thumbYuan Weiwei， Kuang Bin， Zhao Chengli.Department ofplastic and peripheral vascular surgery.Guangdong General Hospital、Guangdong Academy of Medical Sciences， Guangzhou 510080，China

Corresponding author：Yuan Weiwei，Email：yww3229@hotmail.com

【Abstract】Objective To summarize the method of forearm skin flap with dorsal interosseous artery placed by turning the proximal end of the flap to the distal side of the wound to repair skin and soft tissue defect of palm and thumb of hand， and put forward the key points of operation. Methods From 2008 to 2013， the forearm skin flap with interosseous dorsal artery to repair skin and soft tissue defect of palm and the part between thumb and index finger in 20 cases. Dorsal interosseous artery in the forearm is passing through between superficial and deep layers of extensor muscles and sends out 5 -13 cutaneous branches to dorsal antebrachium skin. The large skin flap has good blood supply with high survival rate.Results All flaps survived， and good results were achieved in all 20 cases. Conclusion The flap preserved two main arteries from upper limb with good blood supply， and the amount of blood supply of the flap depended on the size of flap， and the wound of donor site can be directly sutured up or covered with free skin graft， thus minimizing the alteration of appearance and function of donor area.

【Key words】Dorsal interosseous artery； Skin flap； Rehabilitate； Retrograde； Hand wound； Parenchyma； Tissue defect

外傷后手掌、虎口处的皮肤软组织缺损，在修复后要求耐磨及防治挛缩，应选用皮瓣修复。2008-2013年，本科采用骨间背动脉皮瓣逆行转移修复手掌部、虎口处皮肤软组织缺损20例。现报道如下。

1 资料与方法

1.1 一般资料

本组男性17例，女性3例。年龄15～40岁。虎口瘢痕挛缩并拇指内收5例。拇指近节掌侧和虎口软组织缺损3例。手掌部皮肤软组织缺损12例。20例中切取皮瓣的大小面积为6 cm×4 cm～12 cm×5 cm。皮瓣的大小根据软组织缺损及虎口瘢痕挛缩切除松解后软组织缺损的大小具体选择。术后20例均成活。经0.5～3年的随访，皮瓣质软，弹性好，色质与周围皮肤一致，手部循环和外型好，手功能恢复满意。……