Objective To investigate the feasibility of applying serial skin flaps through the perforator vessel chain of the peroneal artery to cover skin defects in two different parts of the wrist and report the clinical efficacy.Methods From July 2008 to December 2011,7 cases of soft tissue defects on both volar and dorsal aspects of the wrist were treated with the serial free peroneal artery perforator flaps.There were 4 cases of simple skin defects and 3 cases of skin defects combined with bone,joint,blood vessel,nerve and tendon injury.The area of skin defect on the volar wrist ranged from 5.8 cm × 4.5 cm to 8.2 cm × 7.0 cm,while that on the dorsal wrist 4.6 cm × 3.2 cm to 7.5 cm × 6.8 cm.All injuries were repaired sub-acutely.The two peroneal artery perforator skin flaps were connected via the vessel chain.When the width of the defect at the lower leg donor site was less than 4.0 cm,the wound was closed by direct suture.Larger defects at the donor site were covered with full thickness skin grafts.Results All 14 flaps of the 7 cases survived.Blisters occurred in the distal flap in 2 cases that healed after suture removal to reduce tension.Seven cases were follow-up for 6 to 24 months,with an average of 10 months.The flaps had satisfactory appearance and soft texture.Skin grafts at the donor sites healed well,with no blisters and ulceration.Conclusion Transfer of serial skin flaps based on peroneal artery perforator vascular chain to cover soft tissue defects on both volar and dorsal aspects of the wrist is a feasible and effective method that leads to good clinical results.

目的 报告利用手指两侧指动脉背侧支血管蒂远端蒂皮瓣瓦合修复手指末节套脱伤的临床效果.方法2007年7月至2009年10月,对10例12指末节套脱伤,采用手指两侧指动脉背侧支为血管蒂的远端蒂皮瓣瓦合修复,其中示指1指、中指6指、环指4指、小指1指.创面面积:1.8 cm× 1.5 cm～ 2.2 cm× 1.5cm.皮瓣切取面积为2.0 cm× 1.5cm～2.5 cm× 1.8 cm.结果术后皮瓣和植皮全部存活.术后7例8指获得7～ 18个月的随访,平均12个月.皮瓣外形饱满,质地柔软,皮瓣回缩后无骨外露,指端无触痛.手指功能及皮瓣感觉恢复满意,两点分辨觉约0.7～ 1.1cm.结论手指两侧指动脉背侧支血管蒂远端蒂皮瓣瓦合修复手指末节套脱伤,该术式操作简单、损伤小、疗效满意,是一种较为理想的手术方法.

目的 总结采用尺动脉腕上皮支皮瓣游离移植修复手指皮肤缺损,并利用其手背尺侧皮支重建手指末梢血运的临床疗效. 方法 2007年5月-2009年5月,收治6例6指中末节指腹皮肤缺损伴末梢血运障碍患者.男4例,女2例;年龄21～56岁,平均31岁.电锯伤4例,其中中指2例,示指1例,环指1例;合并屈肌腱断裂2例.热压伤2例,示、中指各1例.采用尺动脉腕上皮支皮瓣游离移植修复缺损,手背尺侧皮支与远端指动脉吻合重建末梢血运.结果术后6例皮瓣及患指均顺利成活,创面Ⅰ期愈合,无血管危象及感染发生.供区植皮成活,切口Ⅰ期愈合.4例获随访,随访时间6～15个月,平均8个月.皮瓣无明显臃肿及瘢痕挛缩,患指功能恢复正常,远端指体感觉及皮瓣感觉恢复满意,两点辨别觉8～12 mm. 结论 采用带手背尺侧皮支的尺动脉腕上皮支皮瓣既可修复患指皮肤缺损,又可重建末梢血运,疗效满意.

Objective To evaluate clinical outcome of repairing finger skin defect by the innervated reverse island flaps based on the dorsal branches of the digital proper artery.Methods From January 2005 to June 2008,thinty six cases with finger skin defect were treated with the reverse island flaps from the dorsum of the middle and third phalanx based on the dorsal branch of the digital artery used as the pedicle.Meanwhile,the sense was reconstructed with the proper branches of the digital dorsal nerves.The largest flap was 1.5 cm × 3.0 cm.Results The 36 flaps survived completely and followed up for 6 to 12 months,all flaps had satisfactory appearances,soft texture.The two-point discrimination ranged between 6 and 8 mm.And the movements of interphalangteal joints were satisfactory.Conclusions This kind of flap has the advantages of simplicity,non-invasion to the collateral digital artery and nerve,in addition,the sense is regained successfully.It is an ideal alternative for reconstruction of finger skin defects.

目的 报道应用一蒂双叶的跗趾腓侧皮瓣和第二趾胫侧皮瓣游离移植修复手指较大面积皮肤软组织缺损的临床效果. 方法 采用以第一跖背或跖底动脉、足背静脉为蒂的(足母)趾腓侧和第二趾胫侧双叶皮瓣对8例手指皮肤软组织缺损进行游离移植修复. 结果 术后8例双叶皮瓣全部成活,创面均一期愈合.经过6～18个月随访,皮瓣外形色泽质地满意,两点分辨觉为6～8 mm,手指屈伸活动良好. 结论 以第一跖背或跖底动脉、足背静脉为蒂的(足母)趾腓侧和第二趾胫侧双叶皮瓣游离移植修复手指皮肤软组织缺损,是一种符合解剖性修复的手术方法。

ObjectiveTo discuss the surgical procedure of repairing skin defect of fingers by use of tibial side flap of the second toe and evaluate the treatment outcomes.MethodsThirty-six cases of skin defect of the fingers were retrospectively evaluated.Tibial side flap of the second toe was transferred to repair skin defect of the fingers.ResultsAll flaps survived.The follow-up time ranged from 6 to 18 months.All flaps showed good apperance and the function of the hand was satisfactory.ConclusionTibial side flap of the second toe is ideal to repair small size defect of the fingers.

以尺动脉腕上皮支为蒂的前臂尺侧皮瓣移位修复手部皮肤缺损,在国内首先由张高孟等[1]报告.随后,以其为供血动脉的游离皮瓣移植修复手部皮肤缺损的临床应用口益增多[2,3].但对如何选择性应用尺动脉腕上皮支上行支皮瓣和下行支皮瓣的研究较少.2004年2月至2007年8月,我们根据上、下行支的解剖关系以及手指皮肤缺损面积的大小,分别采用游离尺动脉腕上皮支上行支皮瓣和下行支皮瓣对12例手指皮肤缺损患者创面进行移植修复,获得了满意的效果,现报告如下。

Objective To introduce the clinical application of dorsal island flap of the index finger combined with vascularized transfer of fibular pulp flap from the big toe to treat thumb degloving injuries. Methods There were 9 cases of degloved thumbs with intact nail bed in this series. A local island flap from dorsum of the index finger was transferred along with a free vaseularized fibular pulp flap from the big toe to cover the soft tissue defect. Results The patients were followed-up for 6 months to 3 years. All the survived,with excellent color and texture. Nail growth was near normal and appearance and function of the thumb was satisfactory. 2-PD was 8-10 nun. Wound and skin graft at the donor sites healed well and there was no functional impairment. Conclusion Combined transfer of dorsal island flap of the index finger and fibular side flap of the great toe was one of the best options to treat degloving injury of the thumb.