吻合神经的拇指尺背侧皮神经筋膜蒂岛状皮瓣修复示指末节软组织缺损

Clinical application of Neurofasciocutaneous flap on dorsal part of hand in repair of distal index finger injury

目的观察应用吻合神经的拇指尺背侧皮神经筋膜蒂岛状皮瓣修复示指末节桡侧软组织缺损的临床效果。方法对15例示指末节桡侧软组织缺损病例,采用拇指尺背侧皮神经筋膜蒂岛状皮瓣,逆行移位至拇指近节近端尺侧,屈曲示指末节贴紧拇指近节尺侧固定,吻合拇指尺背侧皮神经与示指桡侧指固有神经,皮瓣带蒂修复创面,2、3周后断蒂。结果皮瓣全部成活,随访6～24个月,皮瓣质地柔软、弹性好、耐磨;指端饱满,色泽正常,两点辨别觉6.4￣9.6mm,11例感觉恢复至S3,4例至S4,外观及功能满意。结论应用吻合神经的拇指尺背侧皮神经筋膜蒂岛状皮瓣,术后效果良好,是修复示指末节桡侧软组织缺损较理想的手术方法。

[Objective] To introduce a neurofasciocutaneous flap on dorsal part of hand for the soft tissue defect of the distal index finger. [Method] For the 15 cases with distal index finger injuries, we moved the neurofasciocutaneous flap on dorsal part of hand to the proximal phalanx level of thumb. The index fingers were then fixed to the side of thumb. The surfaces of wounds were covered by island flap with peduncles, which were severed 2 or 3 weeks later. [Result] 15 flaps survived completely. The period of follow-up ranged from 6 months to 2 years. The contour and consistency of the flaps were nearly normal. 2-point discrimination was 6.4-9.6 mm. The appearance and function were with satisfactory. [Conclusion] The neurofasciocutaneous flap on dorsal part of hand is a good flap for coverage of soft tissue defects of the distal index finger.