Free Hypothenar Perforator Flap for Volar Digital Defect Reconstruction ―― A Case Report

利用小魚際肌自由皮瓣做手指腹側軟組織缺損重建－案例報告

林克謙(Ko-Chien Lin) ； 林寶源(Pao-Yuan Lin)

《臺灣整形外科醫學會雜誌》 26卷3期 (2017/09) Pp. 332-337

摘要

Background: Achieving both functional and cosmetic results in the reconstruction of a volar surface defect of the finger is challenging. The hypothenar perforator flap is a good option for small-sized volar surface defect reconstruction of a finger, but is uncommonly used because of the difficult dissection of its small perforators. Aim and Objectives: Due to the advantages of hypothenar flap including identical skin texture and possible primary closure of the donor site, the purpose of this study was to present the result of a case of a volar surface defect of the left middle finger using free hypothenar flap reconstruction. Methods: A 40-year-old male patient presented with a volar surface defect on the ulnar side of the left middle finger. The defect located on the middle phalanx was approximately 2.5×1.5 cm, with exposure of the peritenon of flexor tendon. A hypothenar skin flap was designed and raised to repair the defect. The recipient vessel was a digital artery and vein, and microvascular anastomosis was performed in an end-to-end fashion. The donor site was properly closed. Secondary flap revision was performed two months post-operatively. Results: The flap survived completely, and the donor site healed with an acceptable scar. Near full range of motion of the left middle finger was achieved, and the flap revealed excellent contour and sensibility. Conclusion: The free hypothenar perforator flap is an alternative method to reconstruct the finger defect with bone or tendon exposure and gets acceptable functional and cosmetic outcomes.

關鍵字

volar surface defect ； hypothenar flap ； free flap reconstruction

並列摘要

背景：手指腹側軟組織缺損因位置及組織特性，使得重建的方式選擇有限。目的及目標：本案例報告旨在分享使用小魚際肌自由皮瓣做指腹缺損重建之經驗。方法：患者為40歲男性因工傷造成左手中指腹側約2.5×1.5cm之軟組織缺損合併肌腱外露，我們設計小魚際肌自由皮瓣做顯微重建手術，並於術後兩個月做皮瓣修整手術，期間持續追蹤患處之外觀及手指功能。結果：術後追蹤發現該皮瓣存活良好，手指保有感覺及運動功能，同時外觀上與健指無太大差異。結論：利用小魚際肌自由皮瓣做指腹缺損重建不僅可保有良好的手指功能及外觀，在供皮瓣區也甚少出現併發症，是一種可信賴的重建方式。