指背侧岛状皮瓣在手指皮肤缺损中的临床应用

Repairing skin defect of finger with digital dorsal island flap

目的 探讨以手指背侧微血管网为血管蒂的手指近、中节背侧皮瓣逆行修复手指不同平面皮肤缺损的临床效果.方法 2007年1月-2011年12月,以近节及中节手指桡、尺背侧的手指背侧微血管网为血管蒂,逆行修复手指近指间关节掌侧,及其以远指体掌背侧及侧方皮肤缺损60例78指,皮瓣大小为1.2 cm×2.0 cm～2.5 cm×3.5 cm.结果 术后随访6～36个月,73指皮瓣成活,5指中节指背皮瓣远端部分坏死,经换药后创面愈合.术后皮瓣两点辨别觉8～10 mm,指间关节活动功能好.结论 该皮瓣具有操作简单、不损伤指固有动脉及指固有神经等优点.近节指背皮瓣面积大、血管蒂长、旋转弧大、成功率高.中节指背皮瓣血管蒂短,可用于修复末节甲根及甲中段平面背侧及指侧方皮肤缺损.

Objective To introduce the clinical application of the digital dorsal island flap pedicled with dorsal digit microvascular which was designed in the dorsal area of the middle or the proximal phalanx.Methods From January 2007 to December 2011,skin defects were located near or beyond the proximal interphalangeal joint.60 cases with a total of 78 fingers were treated with a dorsal proximal or middle phalangeal reverse island flap.The flaps were supplied by the deep fascia microvascular network.The area of the flaps ranged from 1.2 cm×2.0 cm～3.5 cm×2.5 cm.Results 73 flaps survived after operation.The distal part of the dorsal flaps got healing after dressing in 5 middle finges.The patients were followed up for 6 to 36 months.The appearance of the repaired fingers was satisfactory,two-point discrimination of the flaps recovered to 8～10 mm.Movement of the proximal interphalangeal joint was normal in all cases.There were no obvious complications in the donor site.Conclusion These flaps combine the advantages of simplicity,non-invasion to the artery or nerves,high success rate,wide coverge,an extended skin pedicle and a versalite pivot point on the phalanx.The vascular pedicle of middle phalangeal reverse island flap is short,which can be used to repair dorsal and lateral skin defect of middle and root of the nail.