带血管蒂皮瓣在指腹缺损中的应用

Application of skin flap with vascular pedicle to the repair of digital pulp defects

目的:报道应用指背筋膜逆行岛状皮瓣、改良指动脉逆行岛状皮瓣、大鱼际桡侧缘远端蒂筋膜皮瓣急诊修复指腹缺损的方法、适应证及临床效果。方法:根据手指指腹缺损的面积及软组织损伤的部位,对80例(92指,其中男42例49指,女38例43指;患者年龄15～59岁,平均29.5岁)的指腹缺损创面采用指背筋膜逆行岛状皮瓣、改良指动脉逆行岛状皮瓣、大鱼际桡侧缘远端蒂筋膜皮瓣进行急诊修复。其中指背筋膜逆行岛状皮瓣修复25指,改良指动脉逆行岛状皮瓣修复52指,大鱼际桡侧缘远端蒂筋膜皮瓣修复15指。皮瓣切取面积1.3cm×1.0cm～3.5cm×2.2cm。结果:80例92指皮瓣全部成活,4指皮瓣发生血管危象,经换药及拆线后,危象解除。随访6～36个月,皮瓣血运、外观、弹性、质地均良好。指腹两点分辨觉:指背筋膜逆行岛状皮瓣平均6.8mm,改良指动脉逆行岛状皮瓣平均为6.5mm,大鱼际桡侧缘远端蒂筋膜皮瓣6.2mm。结论:手部带血管蒂皮瓣修复指腹缺损,手术安全,操作简单,皮瓣质地、外观良好,既可避免两次手术,又能重建感觉功能,是修复指腹缺损较为理想的方法。

Objective ：To report the methods, indication and therapeutic effects of reverse island skin flap of the digital dorsal fascia,modified digital arterial reverse island skin flap or the fascio-cutaneous flap distally pedicled on the radial side of the thenar eminence to repair digital pulp defects. Methods：The defects in 92 fingers of 80 patients（49 fingers of 42 male and 43 fingers of 38 female,the patients age ranged from 15 to 59 years, with an average of 29.5 years）were repaired with reverse island skin flap of digital dorsal fascia, modified digital arterial reverse island skin flap or the fascio-cutaneous flap distally pedicled on the radial side of the thenar eminence according to the area and the position of defects. There were 25 fingers repaired by reverse island skin flap of finger＇s dorsal fascia,52 fingers were repaired by modified reverse island skin flap of finger＇s ar- tery and 15 fingers were repaired by the fascio-cutaneous flap distally pedicled on the radial side of the thenar eminence. The area of flaps ranged from 1.3 cm × 1.0 cm to 3.5 cm × 2.2 cm. Results： The flaps of the 92 fingers of 80 patients all survived. Four fingers of them had vascular crisises, which relieved by changing dressing , and after a period follow-up ranging from 6 to 36 months ,the blood circulation, the appearance, the elasticity, the texture were all good. The two-point discrimination was 6.8 millimeter in the reverse island skin flap of finger＇s dorsal fascia,6.5 millimeter in the modified reverse island skin flap of finger＇s artery and 6.2 millimeter in the fascio-cutaneous flap distally pedicled on the radial side of the thenar eminence. Conclusion：The application of skin flaps with vascular pedicle in repairing of finger＇s defect is easily used and safely operated, the appearance and texture of the skin flap are good, which can avoid the second operation and restore the feeling function.