吻合神经血管的环指指动脉背侧支皮瓣修复指腹缺损

NEUROVASCULAR FREE FLAP BASED ON DORSAL BRANCH OF DIGITAL ARTERY OF RING FINGER FOR FINGER PULP DEFECT

目的探讨应用吻合神经、血管的环指指动脉背侧支皮瓣游离移植修复指腹缺损的手术方法和临床效果。方法2006年2月-2009年5月,收治外伤致手指指腹缺损患者11例11指。男8例,女3例;年龄23～40岁,平均29岁。拇指2例,示指5例,中指4例。均伴肌腱及骨外露,缺损范围1.0cm×1.0cm～2.5cm×2.0cm。受伤至手术时间为1～9h,平均3.5h。术中采用范围为1.5cm×1.5cm～3.0cm×2.5cm的环指指动脉背侧支皮瓣修复缺损,其中5例携带指神经背侧分支,6例携带指背神经。4例皮瓣供区为环指近节桡背侧,7例为环指近节尺背侧;皮瓣切取后供区采用全厚皮片植皮修复。结果术后皮瓣全部成活,创面均Ⅰ期愈合。供区植皮均成活,切口均Ⅰ期愈合。11例均获随访,随访时间6～24个月,平均12个月。除1例皮瓣稍显臃肿外,其余皮瓣质地外形良好。手指远侧指间关节活动正常,指腹两点辨别觉为7～12mm。供指伸屈活动正常,植皮区遗留环状线样瘢痕。结论应用游离环指指动脉背侧支皮瓣修复指腹缺损,手术操作简便,修复后指腹饱满、外形及感觉恢复良好,是一种较好的修复方法。

Objective To investigate the surgical procedures and clinical outcomes of the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect. Methods From February 2006 to May 2009,11 cases （11 fingers） of finger pulp defect with tendon and bone exposure were treated,including 8 males and 3 females with an average age of 29 years （range,23-40 years）. The defect locations were thumb in 2 cases,index finger in 5 cases,and middle finger in 4 cases. The defect size ranged from 1.0 cm × 1.0 cm to 2.5 cm × 2.0 cm. The time from injury to operation was 1-9 hours. The flap size ranged from 1.5 cm × 1.5 cm to 3.0 cm × 2.5 cm. Five flaps carried the dorsal branch of digital nerve,6 flaps carried nervi digitales dorsales. The flaps were cut from proximal radial dorsal ring finger in 4 cases and from promximal ulnar dorsal ring finger in 7 cases. Defect of donor site was repaired with full-thickness skin grafting. Results All flaps and grafted skins survived; wound and incision of donor site achieved healing by first intention. Eleven patients were followed up 6 to 24 months with an average of 12 months. The other finger flaps had good texture and shape except for 1 flap with slightly bloated. The activities of finger distal interphalangeal joint were normal,the two-point discrimination of finger pulp was 7-12 mm. The extension and flexion activities of donor fingers were normal,the ringlike thread scar left at the donor site. Conclusion It is an ideal method to use the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect,which has the advantages of simple operation,good appearance,and functional recovery.