- 期刊
Reconstruction of Skin Defects on Multiple Fingers with a Free Bridging Venous Flap-Case Report
利用單一橋狀自由靜脈皮瓣重建多根手指之皮膚缺損－病例報告
摘要
背景： 手指之皮膚缺損，若伴有肌腱或關節暴露，常需要皮瓣重建。然而要同時重建多根手指之皮膚缺損則較困難。 目的及目標： 我們提出－利用單－橋狀自由靜脈皮瓣重建多根手指皮膚缺損之病例報告。 材料及方法： 一位二十歲女性的左手食指及中指手指被高溫的機器壓傷，受傷十二天後她來門診求診。經手術清創後，其左手食指背側有一從中位指節到甲床基部的皮膚缺損，伴有肌腱暴露。而其中指之皮膚缺損位在遠端指間關節到甲床基部處，其肌腱已壞死且伴有遠端指間關節暴露。我們在其左前臂取一“雪人”狀靜脈皮瓣同時重建食指及中指的皮膚缺損。此皮瓣如同搭橋一般連接兩指，皮瓣一端覆蓋食指之皮膚缺損，另一端覆蓋中指之皮膚缺損，形成暫時性的併指。再將中指尺側指動脈顯微吻合至靜脈皮瓣之遠端靜脈，將靜脈皮瓣之近端靜脈吻合至食指橈側皮下靜脈，形成一“動脈化”的靜脈皮瓣。三星期後我們切斷靜脈皮瓣，分開併指。 結果： 十三個月後，其左手手指有良好之外觀及正常的功能。 結論： 多根手指之皮膚缺損可由單一橋狀自由顯微靜脈皮瓣重建，此橋狀靜脈皮瓣可提供薄而可靠的組織重建多根手指，讓外科醫師可以不用為了要重建多根手指而使用需多次階段性手術的腹部皮瓣，或耗費許多時間同時取多個自由皮瓣進行重建。
關鍵字
無資料並列摘要
Background: Skin defects on multiple digits with joint or tendon exposure is a challenging problem which necessitates simultaneous coverage with a well vascularized tissue. Aim and Objectives: We report a case with skin defects on two fingers reconstructed with a single ”bridging” venous flap. Materials and Methods: A twenty-year-old female came to our clinic for crush and contact burn injury to her left index and middle fingers. After removal of the necrotic skin, a skin defect was noted on the dorsal side of the index finger from the middle phalanx to the nail matrix with exposure of the lateral bands, and the middle finger had a skin defect at the distal phalanx with exposure of the distal interphalangeal joint (DIP joint). A ”snow-man” like free venous flap was harvested from her left forearm to cover the skin defects. One domain of the flap was used to cover the defect on the middle finger and the other domain was used to cover the defect on the index finger, which created temporary syndactyly. Three weeks later the flap was divided. Results: The left hand has a good function at a 13-month follow-up. Conclusion: A single ”bridging” venous flap can be used to reconstruct multiple skin defects on multiple digits simultaneously. The ”bridging” venous flap provides a thin and reliable coverage of the defects and spares the surgeon from a multiple-staged abdominal flap or a long operation of multiple free flaps to cover multiple skin defects.