两种指动脉岛状皮瓣的疗效分析

Treatment outcome of two types of digital artery island flaps

目的分析两种指动脉岛状皮瓣修复手指皮肤缺损的疗效。方法应用指神经血管岛状皮瓣修复拇指掌侧皮肤缺损16例,指动脉指背皮瓣修复手指掌侧皮肤缺损14例。术后分别随访两种方法对供指和受指皮瓣的外观、血液循环和感觉恢复的情况。结果术后平均随访4.1年,供指指神经血管岛状皮瓣组有4例出现近侧指间关节屈曲挛缩;指动脉指背皮瓣组2例出现远侧指间关节伸直受限,指动脉指背皮瓣组供指血液循环和感觉好于指神经血管岛状皮瓣组。受区两组皮瓣外观满意,两组各有4例受指遇冷时出现血运障碍,感觉恢复指神经血管岛状皮瓣组明显好于指动脉指背皮瓣组,但指神经血管岛状皮瓣组有33.2%的皮瓣存在双重感觉。结论指动脉指背皮瓣由于对供指损伤小,能部分恢复伤指感觉,适合修复手指皮肤缺损;对于拇指感觉恢复要求较高的患者,指神经血管岛状皮瓣也有其优势。

Objective Two types of digital artery island flaps were introduced to treat skin defect of the digits, and the treaunent outcome was presented. Methods Sixteen cases of digital neurovascular island flap （NVIF） for coverage of thumb defects and 14 cases of dorsal phalangeal flap （DPF） pedicled with digital artery for finger defects were followed up. The appearance of both donor and recipient digits, circulation and sensory recovery were evaluated. Results Mean follow-up period was 4.1 years. There was slight flexion contracture of the PIP joint in 4 donor fingers of group NVIF, and slight limitation of DIP joint extension in 2 donor fingers of group DPF. Circulation and sensation of donor fingers were better in group DPF than in group NVIF. Appearance of the recipient site was satisfactory in both groups. Cold intolerance was seen in 4 cases for both DPF group and NVIF group. Sensation of the recipient site was better in group NVIF than in group DPF. However double sensation was present in 33.2% of the cases in group NVIF. Conclusion DPF causes less harm to the donor finger and can restore sensation of recipient site to some extent. It is suitable for repairing skin defect of the fingers. NVIF is more suitable for repairing skin defect of the thumb which requires more precise sensory recovery.