摘要目的 探讨指掌侧固有动脉背侧支血管链皮瓣及掌背动脉返支皮瓣接力修复第2～5指的中、末节及供区软组织缺损的临床疗效.方法 自2014年6月至2016年5月,对收治的18例(18指)第2～5指中、末节软组织缺损采用指掌侧固有动脉背侧支血管链逆行皮瓣修复,掌背动脉返支逆行皮瓣修复供区.其中男11例,女7例,平均41岁.右手12例,左手6例.致伤原因:绞伤5例,压砸伤6例,电锯伤及切割伤7例.受伤部位:15例为手指末节软组织缺损,3例为手指中、末节软组织缺损,所有病例均有骨骼、肌腱等深层组织外露.清创后创面面积为1.0 cm×1.8 cm～2.0 cm×3.0 cm.指掌侧固有动脉背侧支血管链皮瓣及掌背动脉返支皮瓣大小分别为1.2 cm×2.0 cm～2.3 cm×3.3 cm和1.4 cm×2.3 cm～2.6 cm×3.6 cm.定期进行随访.结果 术后36块皮瓣全部完全成活,供区切口一期愈合.随访6～15个月,平均11个月.皮瓣外观、质地良好,与周围组织相近;手背供区仅残留线性瘢痕.按照Michigan手部功能问卷评定标准,16例患者对手部整体外观非常满意,2例患者表示满意.手指中、末节皮瓣静态两点辨别觉为5～9 mm.手指活动度参照TAM评定标准,优15例,良3例.结论 采用指掌侧固有动脉背侧支血管链皮瓣及掌背动脉返支皮瓣接力修复第2～5指中、末节及供区软组织缺损,操作简单,血供可靠,疗效满意,改善了指掌侧固有动脉背侧支血管链皮瓣供区外观,并发症少.

abstractsObjective To investigate the clinical effectiveness of the reversed flaps pedicled with lateral vas-cular chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery for relaying repair of soft tissue defects at middle-distal part of the 2nd ～ 5th finger and donor site. Methods From June, 2014 to May, 2016, a total of 18 cases (11 male and 7 female) with soft tissue defects at middle-distal part of 2nd～5th fin-ger were treated with the reversed flap pedicled with lateral vascular chain of dorsal branch of digital artery. The donor site was repaired with the reversed flap pedicled with the perforating branch of the dorsal metacarpal artery. The aver-age age at the time of reconstruction was 41 years. The right hand was involved in 12 cases and the left in 6 cases. The etiologies of injury were avulsion (n=5) , crush (n=6), and saw-cut injury (n=7). There were 15 cases with soft tissue defect at the distal phalanx and 3 cases with loss of distal and middle phalanx. All these cases were exposed with bone or tendon. The defect size ranged from 1.0 cm × 1.8 cm to 2.0 cm × 3.0 cm. And the dimension of the re-versed flaps pedicled with lateral vascular chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery ranged from 1.2 cm × 2.0 cm to 2.3 cm × 3.3 cm, and 1.4 cm × 2.3 cm to 2.6 cm × 3.6 cm, respec-tively. Postoperative follow-up was done termly. Results All flaps survived uneventfully with primary healing at donor site. The mean of followed-up time was 11 months (ranged from 6 to 15 months). The appearance and texture of the flaps were satisfactory and similar to the surrounding tissue. There was only some linear scar left at the dorsum of the palm. On the basis of the MHQ, 16 patients were strongly satisfied (score 5) with the appearance of the flap, and the remaining 2 patients was satisfied (score 4) with the appearance. The static 2-point discrimination of the flaps at the middle-distal part of 2nd～5th finger was 5-9 mm. Based on TAM assessment, the function of the injured finger was graded as excellent in 15 cases, good in 3 cases. Conclusion The relaying reversed flaps pedicled with lat-eral vascular chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery can be applied for repair of soft tissue defects at middle-distal part of 2nd～5th finger and donor site with easy procedure, reliable blood supply, satisfactory results, good appearance as well as less complications at donor sites.