摘要
目的探讨指动脉串、并联岛状皮瓣修复指端或相邻指体、指端脱套伤的临床疗效。方法2008年9月至2012年7月,对收治的32例甲根以远指端脱套伤(或合并末节指骨骨折)的患者,采用指动脉串联逆行岛状皮瓣瓦合修复指端脱套伤13例,修复相邻指体、指端脱套伤11例;采用同一掌侧指总动脉血管蒂的中指尺侧和环指桡侧指动脉并联岛状皮瓣瓦合修复拇指指端脱套伤8例。缺损面积2.0cm×1.8cm~7.2cm×5.5cm,切取皮瓣最小面积为1.1cm×1.0cm~1.5cm×1.3cm,最大面积为3.0cm×2.2cm~5.5cm×4.5cm。供区取中厚皮片移植修复,打包加压包扎。结果1例皮瓣术中游离过程即发生血管痉挛,经局部应用罂粟碱及热敷后解除。1例皮瓣因蒂部缝合太紧,术后发生血液循环障碍,经间断拆线后解除。2例皮瓣术后出现水泡,1周后消失。其余皮瓣均顺利成活,切口及供区植皮均Ⅰ期愈合。随访半年以上的20例患者中,随访采用指动脉串联逆行岛状皮瓣瓦合修复指端脱套伤8例(总13例),随访采用指动脉串联逆行岛状皮瓣瓦合修复相邻指体、指端脱套伤7例(总11例);随访采用同一掌侧指总动脉血管蒂的中指尺侧和环指桡侧指动脉并联岛状皮瓣瓦合修复拇指指端脱套伤5例(总8例);均采用患者来门诊复查进行直接随访。主要随访皮瓣外形、质地、感觉、患指屈伸功能以及供区恢复情况。随访截止时间为皮瓣修复术后12个月。皮瓣外形、质地均良好,恢复保护性感觉,患指屈、伸功能恢复正常。参照中华医学会手外科学会上肢部分功能评定试用标准:优11例,良7例,可2例。供指外形及功能无明显影响。结论采用指动脉串、并联岛状皮瓣修复指端或相邻指体指端脱套伤,具有手术操作简便、安全、可靠等优点,可满足不接受或因身体原因不能接受腹部皮管或躅趾甲瓣修复患者的需求。
Objective To investigate the method and effectiveness of the digital artery series and parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger Methods Between September 2008 and July 2012 ,the finger artery series retrograde island flaps tiled in the repair of finger degloving injury in 13 cases ,repair of adjacent finger tip degloving injury in 11 cases; 8 cases of degloved injuries of the fingertip were tiled with the digital artery parallel island flap from ulnaris middle finger and radialis ring finger of arteria digitalis communis pedicled which were from the same palm side. The size of skin and soft tissue defect ranged from 2. 0 cm × 1.8 cm - 7.2 cm ×5.5 cm, gutted flap minimum ranged from 1.1 cm ×1.0cm-1.5 cm× 1.3cm, and the maximum ranged from 3.0 cm× 2. 2 cm-5.5 cm × 4. 5 cm. The donor sites were repaired with the intermediate split thickness free skin grafts and performed with pressure dressing. Results The group of 32 cases, in 1 case the flap vasospasm occurred in operation of free process, the symptoms disappeared after local application of papaverine and hot compress ; 1 case of flap occurred disturbance of blood circulation after operation because of tight suturing for pedicle, the symptoms relieved after removing the stitches at intervals; 2 cases blisters appeared after operation, disappeared after a week. All skin flaps were survived, incision and skin graft donor sites healed by first intention. Twenty patients were followed-up from 6 to 12 months after operation. All flaps presented the satisfactory appearance and texture, recovered protective feeling. At last follow-up, the two-point discrimination was 7 to 10mm, and the flexion and extension function of wounded fingers recovered to normal. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, there were excellent in 19 cases, good in 10 cases, and moderate in 3 cases. No significant loss to the donor shape and function. Conclusion The surgery by adopted the digital artery series or parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger, not only has the advantages of simpleness, safety and reliability, but also can satisfy the patients who aren't willing to accept or because of physical reasons can't accept the treatment of abdominal skin tube or nail flap from hallux toe, which performs in both high-end and low level hospitals, and deserves of general application.
出处
《中华显微外科杂志》
CSCD
北大核心
2014年第3期225-228,共4页
Chinese Journal of Microsurgery
关键词
指动脉岛状皮瓣
串或并联皮瓣
指脱套伤
瓦合修复
Digital artery of island flap
Series or parallel flap
Degloved injuries of the fingert
Tile flap repairing