重建感觉的指动脉远侧指间关节背侧皮支逆行岛状皮瓣

Innervated reverse island flap based on the dorsal cutaneous branch at distal interphalangeal joint of the digital artery

目的介绍用指动脉远侧指间关节背侧皮支逆行岛状皮瓣修复指端及指腹缺损,并同时重建感觉的一种新的术式. 方法根据指背皮肤血供及神经支配的特点,应用指动脉远侧指间关节背侧皮支为血管蒂的中节指背皮瓣,逆行转移修复指端及指腹缺损,同时应用指背部神经的分支重建指端及指腹感觉3例. 结果术后皮瓣全部存活,随访3～6个月,外形满意,质地柔软,耐磨,无触痛,耐寒冷,动态及静态两点辨别觉分别为2～4 mm及4～6 mm,指间关节活动范围减少在10°以内. 结论该术式不需牺牲主要血管及神经,采用中节指背非功能面的皮肤为供区,并能重建良好的感觉,不需2次手术,是修复指端及指腹缺损可选用的皮瓣之一.

Objective To introduce a new idea of fingertip or pulp reconstruction with the innervated reverse island flap based on the dorsal cutaneous branch at distal interphalangeal joint of the digital artery. Methods Based on the features of blood supply and innervation of digital dorsum, it was harvested for coverage of fingertip or pulp defects for 3 cases of the reverse island flap from the dorsum of the middle phalanx based on the dorsal cutaneous branch at distal interphalangeal joint of the digital artery. Meanwhile, the sense was reconstructed with the proper branches of the digital dorsal nerves. Results All cases survived completely. After following up of 3～6 months, the fingers after reconstruction had satisfactory appearances, soft texture with wear-resisting, without tenderness. No cold intolerance of the involved fingertip or pulp was reported. Static and noving two-point discrimination was 4～6 mm and 2～4 mm respectively. There were no apparent complications in the donated places, and the movements of interphalangeal joints decreased less than 10 degrees. Conclusion The method is one of the one-stage local flaps. It does not require the sacrifice of a collateral digital artery, which may jeopardize an already injured finger. And it leads little disturbance of functional and aesthetic at the donor site. In addition, the sense is regained successfully. It is a good alternative for one-stage reconstruction of fingeritip or pulp defects.