Objective: To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.
Methods: Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases).
Results: All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily.
Conclusion: Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.
目的: 探讨游离带感觉神经肋间动脉穿支皮瓣移植修复手外伤缺损的疗效。.
方法: 2010 年 3 月—2015 年 9 月采用游离带感觉神经肋间动脉穿支皮瓣移植修复 19 例手外伤缺损，其中男 16 例，女 3 例；年龄 18～53 岁，平均 35.2 岁。手背 15 例，手掌 4 例。致伤原因：交通事故伤 8 例，热压伤 5 例，绞压伤 4 例，撕脱伤 2 例。均为手部大面积皮肤软组织全层缺损合并指骨、肌腱、血管神经外露，缺损范围为 10.0 cm×7.0 cm～17.0 cm×8.0 cm。其中急诊手术 12 例，择期手术 7 例。皮瓣厚度为 10～25 mm，皮瓣切取范围为 10.0 cm×7.5 cm～17.0 cm×8.0 cm。皮瓣血管蒂与桡动脉鼻烟窝支（12 例）、桡动脉主干（7 例）及其伴行静脉吻合，皮瓣内肋间神经皮支与前臂外侧皮神经缝合。供区创面直接闭合（14 例）或行中厚皮片移植修复（5 例）。.
结果: 术后皮瓣及植皮均成活，供受区创面均 Ⅰ 期愈合。19 例患者均获随访，随访时间 10～18 个月，平均 12.7 个月。术后手部受区外观及功能恢复良好，未见皮瓣臃肿；皮瓣两点辨别觉为 7～11 mm，平均 8.8 mm。供区直接闭合者术后仅遗留线性瘢痕，供区感觉功能无明显影响。.
结论: 游离带感觉神经肋间动脉穿支皮瓣是修复手外伤缺损的较好方法。.
Keywords: Hand injury; free flap; intercostal artery; perforator flap; sensory reconstruction.