标题：前臂掌侧静脉皮瓣修复手部软组织缺损的临床应用

      作者：武子荃 1，曾德禄 1，卞阳阳 1，高俊杰 2，顾运涛 1，姚江凌 1，孟珠龙 1，彭磊 1，傅鉴 3    (1.海南医学院第一附属医院创伤医学中心，海南 海口 570102；2.开封市济康手外科医院，河南 开封 475000；3.海南医学院创伤与灾难救援重点实验室，海南 海口 570102)

      卷次： 2018年29卷23期

      【摘要】 目的 探讨应用前臂掌侧静脉皮瓣修复手部软组织缺损的临床应用效果。方法 选取 2017年1~6月海南医学院第一附属医院创伤中心诊治的17例手部皮肤软组织缺损的患者，其中男性13例，女性4例，年龄23~55岁，平均34岁；创面缺损面积1.0 cm×1.5 cm~3.0 cm×5.0 cm，切取同侧前臂掌侧游离静脉皮瓣，移植修复手部软组织缺损：根据缺损区面积及形状设计皮瓣，血管采用动脉-静脉-动脉(A-V-A)或静脉-静脉-静脉(V-V-V)吻合方式。结果 17例皮瓣全部成活，供受区伤口愈合良好，术后随访6~12个月，平均8个月。根据中华医学会手外科学会上肢部分功能评定试用标准评价手指功能恢复情况：综合评价 17例皮瓣，优 13例、良 3例、可 1例，优良率为94.1%；感觉恢复：8例S4，6例S3，3例S2，感觉恢复好。除 2例轻度色素沉着外，余皮瓣均外形、色泽良好，无臃肿。结论 应用前臂掌侧静脉皮瓣修复手部软组织缺损是一种理想的手术术式，值得临床推广应用。
      【关键词】 静脉皮瓣；软组织缺损；静脉动脉化；显微手术
      【中图分类号】 R622 【文献标识码】 A 【文章编号】 1003—6350（2018）23—3305—03

Clinical application of forearm vein flap in repairing soft tissue defect of hand.
WU Zi-quan 1, ZENG De-lu 1, BIANYang-yang 1, GAO Jun-jie 2, GU Yun-tao 1, YAO Jiang-ling 1, MENG Zhu-long 1, PENG Lei 1, FU Jian 3. 1. TraumaMedicine Center, the First Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan, CHINA; 2. KaifengJikang Hand Surgery Hospital, Kaifeng 475000, Henan, CHINA; 3. Key Laboratory of Trauma and Disaster Rescue, HainanMedical College, Haikou 570102, Hainan, CHINA
【Abstract】 Objective To explore the clinical application of forearm palmar venous flap in repairing soft tissuedefect of hand. Methods From January 2017 to June 2017, 17 aged 23-55 years patients with skin and soft tissue de-fects of hand, including 13 males and 4 females, with an average age of 34 years, were treated in Trauma Medicine Cen-ter of the First Affiliated Hospital of Hainan Medical College. The defect area was 1.0 cm×1.5 cm to 3.0 cm×5.0 cm, andthe ipsilateral forearm palmar free venous flap was used to repair the soft tissue defect of hand: the flap was designed ac-cording to the area and shape of the defect. The vessels were anastomosed by Artery-Vein-Artery (A-V-A) orVein-Vein-Vein (V-V-V) anastomosis. Results All the 17 cases survived, and the wound healed well. The follow-up pe-riod was 6 to 12 months (8 months in average). According to the evaluation criteria of upper limb function of the Chi-nese Medical Association, the recovery of finger function was evaluated: the flaps were excellent in 13 cases, good in 3cases, fair in 1 case, with excellent and good rate of 94.1%, and sensory recovery was well in 8 cases of S4, 6 cases of S3and 3 cases of S2. Except for 2 cases with slight hyperpigmentation, all the other flaps had good exterior and skin colorwithout bloated. Conclusion The application of forearm metacarpal venous flap to repair the soft tissue defect of handis an ideal surgical method, which is worthy of clinical popularization and application.
      【Key words】 Venous skin flap; Soft tissue defect; Venous arterialization; Microsurgery·论 著·doi:10.3969/j.issn.1003-6350.2018.23.016基金项目：国家自然科学基金(编号：81460339)