探讨超声辅助定位下游离臂内侧皮瓣修复手指创面的手术方法及临床效果。

2022年1月至2023年6月，苏州瑞华骨科医院手外科收治符合入选标准的严重手指损伤保指治疗术后皮肤坏死患者7例(7指)。其中男6例，女1例；年龄16～50岁，平均31岁；手指创面面积3.5 cm×3.0 cm～5.5 cm×4.0 cm，均伴有骨与肌腱外露。患者均二期采用游离臂内侧皮瓣修复创面，皮瓣切取面积为4.0 cm×3.5 cm～6.0 cm×4.5 cm。术前应用彩色多普勒超声辅助定位穿支，术中通过将皮瓣源血管或穿支血管与手指指动脉及皮下静脉吻合重建皮瓣血供，皮瓣供区直接拉拢缝合。术后予抗感染、抗凝、抗血管痉挛等治疗，观察皮瓣存活情况。随访观察皮瓣外形、质地、感觉及供区恢复情况，末次随访时采用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。

7例患者皮瓣全部成活，其中1例术后出现静脉回流障碍，予皮瓣切口湿敷及放血治疗后顺利成活，术区伤口均一期愈合。随访5～15个月，平均7个月，皮瓣外形满意，质地柔软，感觉恢复至S2～S3＋。皮瓣供区遗留线状瘢痕，功能正常。手指功能恢复良好，优3例，良3例，可1例，优良率85.7%。

应用游离臂内侧皮瓣修复手指保指术后存留创面，可保留指体完整性，且皮瓣切取方便，供区相对隐蔽，修复效果较好。

To explore the surgical method and clinical effect of the free medial arm flap to repair the finger wound with ultrasound-assisted positioning.

From January 2022 to June 2023, 7 patients (7 fingers) with skin necrosis after finger preserving treatment who met the inclusion criteria were admitted to Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, including 6 males and 1 female, aged from 16 to 50 years, with an average of 31 years old. The finger wounds area were 3.5 cm×3.0 cm to 5.5 cm×4.0 cm, and all wounds accompanied by bone and tendon exposure. All the wounds were repaired by using the free medial arm flap in the second stage. Color Doppler ultrasound was used to locate the perforating vessels before the operation. During the operation, the source or perforating vessels of the flap were anastomosed with the digital artery and subcutaneous vein of the finger in the recipient area to establish the blood supply of the flap. The area of the medial arm flap ranged from 4.0 cm×3.5 cm to 6.0 cm×4.5 cm, and all the donor areas of the arm were sutured directly. After operation, the patients were treated with anti-infection, anticoagulation and anti-vasospasm, and the survival of the flap was observed. During follow-up, the appearance, texture, and sensation of the flaps, and the wound healing of the donor area were observed. At the last follow-up, the function of the fingers was assessed according to the trial standard of upper limb partial function assessment of the Hand Surgery Society of Chinese Medical Association.

All the flaps grafted in 7 patients survived, in which one patient developed venous reflux disturbance after operation, and survived successfully after wet compress and bloodletting of the flap incision. The wounds in the operative area of all patients healed at the first stage. The follow-up period ranged from 5 to 15 months, with an average of 7 months. All flaps were in good appearance and soft texture, the sensation recovered to S2-S3+. All the donor areas of the arm showed linear scar and the function was normal. At the last follow-up, the finger function was evaluated as excellent in 3 cases, good in 3 cases and fair in 1 case, with an excellent and good rate at 85.7%.

The application of free medial arm flap to repair the postoperative wound of the finger can maintain the integrity of the finger body. The flap is convenient for transplantation, the supply area is relatively hidden, and the repair effect is good.