摘要目的 探讨游离尺动脉远端穿支皮瓣修复手部皮肤软组织缺损的手术方法和临床疗效. 方法 2001年3月至2012年12月,我院对90例手部皮肤软组织缺损伤患者,以尺动脉前臂远端穿支设计游离皮瓣移植修复手部创面.其中急诊或延期手术74例,手指瘢痕挛缩二期手术修复16例.其中34例术中吻合尺神经手背支与指固有神经或指背神经以重建感觉功能. 结果 术后89例皮瓣成活,1例坏死,经换药植皮后愈合.随访时间3～ 36个月(平均12个月),修复后的皮瓣不臃肿,质地良好.手指功能恢复满意,34例修复感觉神经者感觉恢复S3～S3+,16例瘢痕挛缩患者手指主被动活动度明显改善.供区72例直接缝合者切口愈合良好,无明显瘢痕挛缩,18例创面植皮均成活,植皮无挛缩. 结论 游离尺动脉远端穿支皮瓣穿出点较恒定,不损伤主要血管,对供区损伤小,且可携带感觉神经,修复后皮瓣外形、质地良好,皮瓣感觉及手功能恢复均较满意.

abstractsObjective To explore the surgical methods and clinical application effects of repairing hand soft tissue defect with free vascularized flaps based on the distal perforator of ulnar artery.Methods From March, 2001 to December, 2012 in our hospital, 90 patients with hand soft tissue defects were repaired by free vascularized flaps based on the distal perforator of ulnar artery, including 74 patients cases were repaired by Phase Ⅰ emergency surgery, 16 patients cases with scar contracture were repaired by Phase Ⅱ surgery.There were 34 cases were rebuild the sensory by repaired the continuity between the dorsal branch of the ulnar nerve and dorsal digital nerve or palmar digital nerve.The free vascularized flaps that used the emerging point of perforator of the ulnar artery as center of the flap was designed, which based on the distal perforator to repairing the hand soft tissue defect.Results All 89 patients postoperative flaps were survived.Necrosis was seen in 1 flap which was repaired by skin grafting.Follow-up ranged from 3 to 36 months with an average of 12 months.The appearance of flap was not clumsy, the quality was good.The sensation was S3-S3+ in 34 cases after nerve reconstruction surgery.The active and passive activity of 16 cases with scar contracture were improved significantly.The incision in 72 cases for direct suture were healed without scar contracture, 18 cases of skin grafts were all survived without contracture.Conclusion The free vascularized flaps based on the distal perforator of ulnar artery has constant perforating point, which can carry sensory nerves and leads to little donor site damage without major vascular injury.The flap serves as a simple approach to repair hand defects, and get satisfied skin flap appearance and texture, the fingers feel and function recovered well.