指掌侧横形岛状皮瓣修复指腹缺损

REPAIR OF FINGER PULP DEFECT WITH TRANSVERSE DIGITAL PALMAR ISLAND FLAP

目的探讨指掌侧横形岛状皮瓣修复指腹皮肤软组织缺损的方法和临床疗效。方法2007年8月-2008年9月,收治9例指腹皮肤软组织缺损。男6例,女3例;年龄18～48岁。机器冲压伤6例,重物压伤2例,砂轮磨伤1例。示指4例,中指2例,环指3例。缺损部位:近节指腹1例,中节指腹7例,末节指腹1例。缺损范围为1.3cm×1.0cm～2.5cm×1.5cm。其中伴一侧血管、神经束缺损8例,骨折2例,肌腱外露5例。受伤至入院时间20min～14h。术中采用大小为2.0cm×1.2cm～4.0cm×1.7cm的指掌侧横形岛状皮瓣修复软组织缺损。供区采用全厚皮片植皮修复。结果术后皮瓣及供区植皮均顺利成活,切口Ⅰ期愈合。9例术后均获随访,随访时间6～17个月。皮瓣外观与健侧相似,无明显色素沉着及瘢痕挛缩,两点辨别觉为8～11mm。根据中华医学会手外科学会断指再植功能评定试用标准:优8例,良1例。结论采用指掌侧横形岛状皮瓣修复手指中、末节指腹皮肤和软组织缺损,手术操作简便,可获得良好临床疗效。

Objective To investigate the method and clinical outcomes of repairing the skin and tissue defect of the fi nger pulp with transverse digital palmar island flap. Methods From August 2007 to September 2008,9 patients with skin and tissue defects of the f inger pulp were treated,including 6 males and 3 females aged 18-48 years old. The defect was caused by crush injury by machine in 6 cases,pressure injury by heavy objects in 2 cases,and abrasion injury by grinding wheel in 1 case. The defect was located in the index fi nger in 4 cases,the middle fi nger in 2 cases,the ring fi nger in 3 cases,the proximal phalanx in 1 case,the middle phalanx in 7 cases,and the distal phalanx in 1 case. The defect size ranged from 1.3 cm × 1.0 cm to 2.5 cm × 1.5 cm. The defect was complicated with unilateral blood vessel and nerve defect in 8 cases,bone fracture in 2 cases,and tendon exposure in 5 cases. The time between injury and hospital admission was 20 minutes-14 hours. Transverse digital palmar island flaps （2.0 cm × 1.2 cm-4.0 cm × 1.7 cm） were used to repair the soft tissue defect during operation. The donor site was repaired with full-thickness skin graft. Results All the flaps and skin graft at the donor site survived uneventfully. All the wounds healed by first intention. Nine patients were followed up for 6-17 months. The appearance of the flaps was similar to that of the uninjured side,there was no occurrence of obvious pigmentation and scar contracture,and the two-point discrimination value was 8-11 mm. According to the function evaluation standard for the replantation of severed fi nger by Chinese Medical Association Hand Surgery Academy,8 cases were graded as excellent,1 as good. Conclusion Repairing the skin and tissue defects in the finger pulp of middle and distal phalanx with transverse digital palmar island flap can simplify the operation procedure,reduce the suffering of the patient,and provide satisfying therapeutic effect.