外伤性手指软组织缺损的美学修复

Aesthetic reconstruction of traumatic tissue loss of the fingers

目的 探讨手指软组织缺损的美学修复方法。方法 对 67例手指外伤性软组织缺损的病例 ,分别选择 8种不同皮瓣进行修复。结果 61例皮瓣全部成活。 2例皮瓣坏死 ,缩短指骨后伤口愈合 ;4例皮瓣部分坏死 ,经换药后愈合。术后 6个月随访 ,61例患指外形满意 ,皮瓣无臃肿 ,质地柔软 ,无冻伤 ,两点分辨觉达 4～ 7mm ,手指活动基本正常。 6例皮瓣质地较硬 ,手指末端皮肤有瘢痕挛缩 ,甲根向患侧偏斜。结论 伤指皮瓣的选用、手术操作及皮瓣一期愈合 ,对手指外形的重建起到重要作用。

ObjectiveTo discuss the selection of various flaps for aesthetic repair of soft tissue loss in the fingers.Methods8 different flaps were used to treat 67 cases of traumatic tissue loss of the fingers. These included digital artery island flap, distally based digital artery island flap, kite flap, cross finger flap, temporoparietal fascial flap, wrap around flap, distally based flap from dorsum of the index finger, and distally based flap from the thumb. Follow up lasted for 6 months.Results61 flaps survived completely. There were 4 flaps of partial necrosis and 2 complete necrosis. The appearance and consistency of the 61 surviving flaps was satisfactory. 2 point discrimination recovered to 4 mm～7 mm. The fingers regained near normal range of motion. Secondary healing was achieved in 6 necrosed flaps but led to scar contracture and nail deformity.ConclusionIn reconstruction of soft tissue loss of the fingers, both wound coverage and cosmesis should be taken into consideration. Our results suggested that different skin flaps and designs should be selected in individual cases. Survival and primary healing of the skin flaps is the key to success.