吻合血管的双叶复合皮瓣瓦合修复手指套脱伤

Single pedicled double flank flaps from the foot for repair of multiple finger degloving injuries

目的探讨手指皮肤套脱伤(或部分套脱伤)选用足部游离组织移植修复创面的新术式。方法以第一跖背或跖底动脉、足背静脉、趾神经为蒂,切取(足母)趾腓侧皮瓣及第二趾背侧甲皮瓣(保留第二趾)的双叶复合皮瓣移植瓦合修复手指皮肤套脱伤。血管蒂与指总动脉、掌背静脉、指神经吻合。结果术后6例皮瓣全部成活。随访时间为6～12个月,受区手指外形逼真,主动伸屈功能良好,两点分辨觉达5～7mm。供足外形及功能正常。结论以第一跖背或跖底动脉为蒂的(足母)趾腓侧皮瓣、第二趾背侧甲皮瓣双叶复合皮瓣游离移植修复手指套脱伤,是一种符合“生理性修复”的手术方法。

Objective To investigate a simple and effective procedure for repair of soft tissue defect of multiple finger degloving injuries. Methods A bifoliate combined flap was formed by a fibular side skin flap from the big toe and a dorsal onychocutaneous flap from the second toe both based on the first dorsal metatarsal artery or deep plantar artery. The dorsal foot veins and digital nerves were also included in the flap. The flap was tin＇erred to the hand and the artery, veins and nerves were anastomosed with the common digital artery, dorsal veins of the hand, and the digital nerves respectively. This technique was used in 6 cases of degloving injury of adjacent fingers. Results All cases were followed-up for 6 to 12 months. Flap survival was 100%. The function and appearance of the recipient fingers was satisfactory. Two point discrimination was 5 to 7 mm. Donor site morbidity was acceptable. Conclusion Bifoliate combined flap from the big toe and second toe with a single pedicle of either the first dorsal metatarsal artery or deep plantar artery is a ＂physiological＂ flap for repairing of degloving injury of adjacent fingers.