摘要目的 探讨应用两种微型游离皮瓣修复手指皮肤缺损的临床疗效.方法 回顾性分析2014年8月至2017年2月在我院收治的45例两种微型皮瓣游离移植修复手指皮肤缺损患者,其中桡动脉掌浅支穿支皮瓣组24例(创面面积1.8 cm×1.5 cm ~ 4.0 cm×2.5 cm,皮瓣切取面积2.0 cm×1.7 cm ~ 4.2 cm×2.6 cm),趾背动脉皮瓣组21例(创面面积2.0 cm×1.5 cm ~ 3.8 cm×3.0 cm,皮瓣切取面积2.2 cm×1.6 cm ~ 3.9 cm×3.2 cm),术后对两组皮瓣的成活率、皮瓣感觉、供区并发症、手的功能恢复和外观进行比较分析,收集的资料用SPSS22.0统计学软件进行统计学分析.结果 两组皮瓣平均随访15个月,皮瓣全部一期成活,未出现血管危象.皮瓣质地柔软,外观不臃肿.两组病例感觉恢复良好,桡动脉掌浅支穿支皮瓣组两点辨别觉7.0 ~9.0 mm,平均(7.85±1.15)mm,趾背动脉皮瓣组两点辨别觉恢复至6.0 ~ 8.0 mm,平均(6.50±0.94)mm,均达到S3+级以上,差异有统计学意义(P < 0.05);综合质地感觉两组优良率与差的例数间比较,差异无统计学意义(P > 0.05);供区并发症用供区瘢痕挛缩程度来比较,桡动脉掌浅支穿支皮瓣瘢痕挛缩程度轻于趾背动脉皮瓣,差异有统计学意义(P<0.05);两组各指骨间关节活动度与健侧相比差异无统计学意义(P > 0.05).结论 桡动脉掌浅支穿支皮瓣和趾背动脉皮瓣具有血管解剖恒定,血供可靠,外形功能满意,供区损伤小等特点,是精细修复手指皮肤缺损的理想皮瓣;桡动脉掌浅支穿支皮瓣可携带神经及肌腱形成复合组织瓣,手术在同一视野完成,趾背动脉皮瓣在感觉和外观上更有优势.

abstractsObjective Discuss the clinical efficacy by using two kinds of mini perforator free flap for digital injuries reconstruction. Methods From August, 2014 to February, 2017, 45 patients were managed randomly with either radial artery superficial palmar branch(RASPB)perforator free flap or digital artery(DA)perforator free flap for digital skin defects reconstruction, and they were therefore divided into two groups according to the flap type. There were 24 patients in RASPB group, with an average wound dimensions ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm, and an average harvested flap size ranged from 2.0 cm×1.7 cm to 4.2 cm×2.6 cm. Another 21 patients were in DA group, with an average wound dimensions ranged from 2.0 cm×1.5 cm to 3.8 cm×3.0 cm, and an average harvested flap size ranged from 2.2 cm×1.6 cm to 3.9 cm×3.2 cm. The survival rate, sensory function, donor site complications, hand function recovery and aesthetic outcomes of two groups were compared by the SPSS22.0 statistical software after surgery. Results The mean follow up period was 15 months. All flaps were primary survived without vascular crisis. The flaps were soft in texture,trimness in appearance and none of them overtop the normal skin for more than 0.5 cm. Both groups had a favorable sensory recovery.All cases recovery to S3+or better.In Group RASPB,the mean two point discrimination(2 PD)was 7.85±1.15 mm(ranged from 7.0 mm to 9.0 mm). And it was 6.02±0.94 mm(ranged from 6.0 mm to 8.0 mm)in DA group. The difference between two groups was statistically significant(P <0.05). Then we synthetically analyzed flap texture and sensory function,and calculated the qualified ratio of each group.There was no significant difference between two groups(P > 0.05). The degree of scar contracture demonstrated donor site compli cations in RASPB group was lesser than that in DA group(P<0.05).The range of motion of interphalangeal joint was used to reflect the hand function. And we calculated the ratio of repaired and contralateral sites. The difference of the mean ratio between two groups was not statistically significant(P>0.05). Conclusion On account of the characteristics of invariant anatomy position, sufficient blood supply, favorable aesthetic outcome and minimal donor site mobility, both RASPB perforator flap and DA perforator flap were optimal for digital skin defects reconstruction.Besides,incorporated with nerve and tendon,the RASPB perforator flap can also be used for complex tissue transplantation,and the surgery field was only on the arm.While the DA perforator free flap had an advantage of better sensory recovery and appearance.