带感觉支指背筋膜逆行岛状皮瓣修复手指皮肤缺损

A reverse dorsal digital island fascial flap with the dorsal digital sensory nerves for repairing skin defect of the finger

目的探讨以指背筋膜为蒂、带指固有神经背侧支的指背筋膜逆行岛状皮瓣修复手指皮肤缺损的疗效。方法回顾性分析2005年至2008年应用带指固有神经背侧支的指背筋膜逆行岛状皮瓣修复手指皮肤缺损20例25指。术中根据损伤部位和特点,在伤指近节背桡侧或背尺侧设计皮瓣,皮瓣侧缘不超过手指侧中线,旋转点位于远侧指间关节背桡侧或背尺侧,轴心线与手指纵轴平行。深筋膜下锐性分离,逆行转移修复指端缺损。如修复指腹,将皮瓣内含指固有神经背侧支,在皮瓣转位后将其与创面指固有神经吻合。并对皮瓣的设计、切取、成活特点及治疗效果进行观察。结果皮瓣全部成活。随访8～24个月,平均20个月。修复后的手指外观与功能良好,质地柔软,两点辨别觉达0.4～0.6cm。结论带指固有神经背侧支的指背筋膜逆行岛状皮瓣切取简单,对供区损伤小,转移随意性强,外观好,转移后能恢复较好的感觉,是修复手指皮肤缺损的理想皮瓣。

Objective To explore the effects of using a reversed digital dorsal fascial vascular pedicled island fascial flap with the dorsal digital sensory nerves for repairing skin defect of the finger. Methods From 2005 to 2008,a total of 2fi fingers in 20 patients were treated with this flap.According to locations and characteristics of the injury, skin flap was designed on the radial-dorsal or ulnar-dorsal side of the proximal phalanx of the fingers. The lateral margins of the flap did not cross the midlateral line, the axial point was designed on the ulnar or radial dorsum of the distal interphalangeal joint .The axis was paralleled to the longitudinal axis of finger .Dissection was carried out under the deep fascia. The flap was then brought to the fingertip retrogradely to repair the skin defect.When the defect was at the finger pulp,the dorsal branch of the proper digital nerve of the skin flap was anastomosed with the proper digital nerve of the recipient finger.The design,dissection,survival characteristics and treatment outcome were observed. Results All flaps survived completely . Postoperative follow up ranged from 8 months to 24 months,with an average of 20 months.The function and appearance of the fingers were satisfactory. Two-point discrimination recovered 0.4 cm to 0.6 cm. Conclusions The flap is easy to harvest, has a big arc of transfer and good appearance,causes minor morbidity to the donor site and can restore good sensation after operation.It is an ideal flap for repairing skin defect of the finger.