游离同侧前臂穿支皮瓣修复指端缺损

一例游离股前外侧皮瓣的术后护理皮瓣是创面如有骨、关节、肌腱、神经、血管等裸露时，不能用游离皮片进行修复，必须用皮瓣移植修复。

皮瓣是带有自身血液供应、包含皮肤组织的活的组织块，而股前外侧皮瓣是以旋股外侧动脉降支为血管蒂的前外侧皮瓣。

随着显微外科技术的发展，皮瓣的存活率很高，但预后还存在较多问题。

故术后需密切观察病情，及时处理并发症，进行功能锻炼等综合性护理干预。

本院于2021年4月接诊一例左足骨外露患者，经过术后的精心治疗与护理，患者左足皮瓣存活，末梢血运尚可，毛细血管返流正常，生命体征平稳，现将护理体会报告如下：1患者资料患者谢XX，男，68岁，2021年2月25日因车祸碾压致左足毁损伴疼痛1小时余急诊入院。

入院查体：神清，精神差，痛苦貌。

急诊大厅探查伤口见:左足毁损严重，足背、内侧、足底皮肤撕脱毁损，缺损面积约15×20cm，深层骨、肌腱外露，创面渗血，踇趾完全毁损，第2-5足趾淤青。

急诊诊断“左下肢开放性足毁损伤，左足第3跖骨骨折”收入我科,由急诊大厅直接入手术室，在急诊全麻下行“左下肢清创术+血管探查术+截指残端修整术+负压吸引术”。

术后第1天，遵医嘱予以“NS 500ml+庆大霉素16万IU ”冲洗左下肢VSD引流管，在位畅，足第2-4趾血运正常。

遵医嘱予以头孢呋辛钠消炎，帕瑞昔布止疼对症处理，指导患者床上翻身。

于3月4日行二次手术，在全麻下行“左足清创+游离股前外侧皮瓣修复创面+游离植皮术”，左足皮瓣颜色、温度、毛细血管返流实验均正常，肿胀（+），床边灯烤保暖，予以抬高患肢，予以q2h观察血运勿压迫皮瓣，予以氧气3L/min吸入，床边心电监护，生命体征平稳。

遵医嘱予以抗炎、镇痛、活血、补液对症处理，皮瓣相关知识宣教。

指导患者进行蹬自行车运动，踝泵运动。

术后第二十四天，左足皮瓣存活，血运良好，足前方植皮存活，植皮愈合佳，大腿供区愈合佳，大腿切口愈合良好。

足趾末梢血运正常，无红肿渗出。

- 124 -①宁德市蕉城区医院　福建　宁德　352100前臂掌侧静脉皮瓣和SPBRA皮瓣桥接修复伴有指掌侧固有动脉缺损的手指创面患者的效果对比张雅营①【摘要】　目的：分析并比较前臂掌侧静脉皮瓣和桡动脉掌浅支（SPBRA）皮瓣桥接修复伴有指掌侧固有动脉缺损的手指创面患者的效果。

方法：选取2018年3月—2022年12月宁德市蕉城区医院收治的75例伴有指掌侧固有动脉缺损的手指创面患者，按照治疗方式的不同将其分为两组，A 组（n =37）给予前臂掌侧静脉皮瓣修复，B 组（n =38）给予SPBRA 皮瓣桥接修复，观察比较两组手术相关情况、指间关节活动度、感觉功能、并发症发生率及皮瓣存活率。

结果：两组手术时间、皮瓣制作时间比较，差异无统计学意义（P >0.05），B 组创面愈合时间短于A 组，差异有统计学意义（P <0.05）。

术后6个月，两组近、远指间关节屈曲活动度均高于术前，但两组间比较，差异无统计学意义（P >0.05）。

术后6个月，B 组患指感觉功能优于A 组，静止两点辨别觉（S2-PD）高于A 组，差异有统计学意义（P <0.05）。

B 组皮瓣成活率为89.47%（34/38），高于A 组的70.27%（26/37），差异有统计学意义（χ2=4.321，P =0.038）。

两组各项并发症发生率比较，差异无统计学意义（P >0.05）。

结论：在伴有指掌侧固有动脉缺损的手指创面患者中应用前臂掌侧静脉皮瓣、SPBRA 皮瓣桥接修复手术效果相当，具有一定安全性，但SPBRA 皮瓣桥接修复手术皮瓣存活率更高，能够有效改善患者感觉功能，促进创面恢复。

【关键词】　前臂掌侧静脉皮瓣　桡动脉掌浅支　指掌侧固有动脉缺损　手指创面　感觉功能 doi：10.14033/ki.cfmr.2023.32.031 文献标识码　B 文章编号　1674-6805（2023）32-0124-05 Comparison of the Effect of the Palmar Forearm Vein Flap and SPBRA Flap Bridging in Repairing Finger Wound with Defect in the Palmar Proper Artery of the Fingers/ZHANG Yaying. //Chinese and Foreign Medical Research, 2023, 21(32): 124-128 [Abstract]　Objective: To analyze and compare the effect of the palmar forearm vein flap and the superficial palmar branch radial artery (SPBRA) flap bridging in repairing the finger wound with defect in the palmar proper artery of the fingers. Method: A total of 75 patients with finger wound with defect in the palmar proper artery of the fingers treated in Jiaocheng District Hospital of Ningde City from March 2018 to December 2022 were selected and divided into two groups according to different treatment methods. Group A (n =37) was given palmar forearm vein flap repair; group B (n =38) was given SPBRA flap bridge repair. The operative conditions, interphalangeal joint motion, sensory function, complication rate and flap survival rate were observed and compared in the two groups. Result: There were no significant differences in surgery time and flap making time between the two groups (P >0.05). The wound healing time in group B was shorter than that in group A, and the difference was statistically significant (P <0.05). At 6 months after surgery, the flexion motion of proximal and distal interphalangeal joint in both groups were higher than those before surgery, but there were no significant differences between the two groups (P >0.05). At 6 months after surgery, the sensory function of the affected finger in group B was better than that in group A, and static 2-point discrimination (S2-PD) was higher than that in group A, the differences were statistically significant (P <0.05). The survival rate of flaps in group B was 89.47% (34/38), which was higher than 70.27% (26/37) in group A, the difference was statistically significant (χ2=4.321, P =0.038). There was no significant difference in the incidence of complications between the two groups (P >0.05). Conclusion: In patients with finger wound with defect in the palmar proper artery of the fingers, palmar forearm vein flap and SPBRA flap bridging surgery have similar results and have certain safety. However, SPBRA flap bridging surgery has a higher survival rate, which can effectively improve patients' sensory function and promote wound recovery. [Key words]　Palmar forearm vein flap　Superficial palmar branch radial artery　Finger palmar proper artery defect　Finger wound surface　Sensory function First-author's address: Jiaocheng District Hospital of Ningde City, Ningde 352100, China 手指软组织缺损在临床手外科手术中较为多见，多合并神经血管及肌腱外露损伤，修复较为棘手，尤其是在手指软组织缺损的同时伴有指掌侧固有动脉损伤时，需对手指创面和指掌固有动脉同时进行修复，其中邻指、足背、腹部、掌背动脉岛状瓣等皮瓣修复是以往手指软组织缺损创面修复的常用术式，但经临床实践发现以上手术均牺牲一侧指掌侧固有动脉，而固有动脉修复的不完整将会影响术后指端的血液供应，引起手指萎缩、皮温低、畏寒等一系列病症[1]。

前臂游离皮瓣制备
前臂游离皮瓣制备是一种手术技术，主要用于修复人体组织的缺损。

以下是这种技术的基本步骤：
- 术前准备：医生会根据患者的病情和身体状况，制定手术方案。

- 切取皮瓣：在患者前臂按长、宽度、形状切取吻合的游离皮瓣。

- 制备皮瓣：将前臂血管、神经毫无损伤地游离取下，制成游离皮瓣。

- 吻合血管：将游离皮瓣的血管与面部动、静脉相互吻合。

- 术后处理：对患者进行抗感染、活血、解痉、制动等对症支持治疗。

前臂游离皮瓣制备手术难度大、风险高，需要经验丰富的医生进行操作，且患者需要在术后进行严格的康复护理。