同指尺侧顺行岛状皮瓣覆盖回植指骨及甲床修复拇指指尖离断伤

FORWARD HOMODIGITAL ULNARIS ARTERY FLAP COVERAGE FOR BONE AND NAIL BED GRAFT IN THUMB FINGERTIP AMPUTATION

目的探讨同指尺侧顺行岛状皮瓣覆盖回植指骨及甲床,修复拇指指尖离断伤的显微修复方法及临床效果。方法2005年3月-2007年10月,收治6例拇指指尖离断伤患者。男4例,女2例;年龄23～63岁。重物压砸伤3例,切割伤2例,其他伤1例。离断平面:甲根平面2例,甲中平面3例,甲床远1/3平面1例。伤后至手术时间3～10h。术中采用1.5cm×1.4cm～2.0cm×1.4cm同指尺侧顺行岛状皮瓣覆盖回植指骨及甲床修复离断伤。供区取离断指端掌侧皮肤修成全厚皮回植。结果术后6例皮瓣全部成活,5例切口Ⅰ期愈合;1例因术后皮瓣肿胀,经拆除部分缝线换药后Ⅱ期愈合。供区植皮成活,切口Ⅰ期愈合。6例均获随访,随访时间6～8个月。皮瓣血运良好,质软,弹性及色泽良好,无臃肿。两点辨别觉5～6mm。X线片检查示回植末节指骨均愈合,愈合时间为4～5周。拇指无短缩,各关节活动无影响,甲床生长良好,指甲平整。结论应用同指尺侧顺行岛状皮瓣覆盖营养回植的指骨及甲床修复拇指指尖离断,为无再植条件的拇指指尖离断伤提供了一种新的修复方法。

Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery ap coverage for bone and nail bed graft.Methods From March 2005 to October 2007, 6 cases of amputated thumb ngertip（6 ngers） were treated, including 4 males and 2 females and aging 23-63 years.Six patients＇（3 crush injuries, 2 cut injuries and 1 other injury） amputated level was at nail root（2 cases）, mid-nail（3 cases）, and the distal one third of nai bed（1 case）.The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery ap coverage for bone and nail bed graft.The aps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm.Results All aps survived.Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swelling.All skin grafting at donor site survived in one-stage.All patients were followed up for 6-8 months.The appearance of aps were good, and the two-point discrimination was 5-6 mm.Bone graft were healed, the healing time was 4-5 weeks.All nger nails were smooth and at without pain.Conclusion When there was no indication of replantation in thumb ngertip amputation, establishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery ap coverage for bone and nail bed graft.