拇指尺背侧动脉逆行岛状皮瓣修复拇指远节软组织缺损

APPLICATION OF THE DORSOULNAR ARTERIAL RETROGRADE FLAP OF THE THUMB TO REPAIR OF SOFT TISSUE DEFECT AT THE DISTAL THUMB

目的 介绍以拇指尺背侧动脉为蒂逆行皮瓣修复软组织缺损的手术方法和适应证。 方法 2 0 0 0年3月～ 2 0 0 1年 3月 ,应用以拇指尺背侧动脉为蒂的逆行岛状皮瓣 ,修复拇指远节软组织缺损伴指骨外露 12例。其中 ,在距甲皱襞 1.0 cm处的远端旋转点逆行移位皮瓣 2例 ,距甲皱襞 2 .5 cm处的近端旋转点逆行移位皮瓣 10例。切取皮瓣为 1.1cm× 1.3cm～ 1.8cm× 2 .5 cm。 结果 术后 12例皮瓣完全成活 ,均获 2～ 14个月随访 ,指间关节活动度与健侧相同 ;指腹缺损修复 6例皮瓣两点辨别觉为 8～ 10 mm。在远端旋转点移位的 2例 ,术后拇指远节臃肿 ,影响美观。近端旋转点移位的 10例外形满意。

Objective To introduce the surgical procedure and indication of the dorsoulnar arterial retrograde flap of the thumb in repair of soft tissue defect. Methods From March 2000 to March 2001, 12 cases of soft tissue defect with exposed bone at the distal thumb were involved. Ten flaps were pedicled distally at the proximal rotation point, 2 5 cm proximal to the cuticule. Two flaps were pedicled distally at the distal rotation point, 1.0 cm proximal to the cuticule. The flaps harvested in this study were 1.1 cm×1.3 cm to 1.8 cm×2.5 cm.Results All the flaps survived. After an follow up of 2 to 14 months postoperatively, the appearance of the thumbs were satisfactory, except those of 2 thumbs repaired by the flaps transferred at the distal rotation point, which were bulkiness because of the uncovered pedicle. In 6 cases, the defect of finger pulp was repaired, and the 2 point discrimination was measured 8 10 mm. The same range of motion of the thumb IP joint were observed in both sides in all cases.Conclusion The optimal indication of the procedure is soft tissue defect at the distal thumb.