大鱼际桡侧逆行岛状瓣修复拇指末节软组织缺损的临床研究

目的探讨带血管神经蒂的大鱼际桡侧逆行岛状瓣修复拇指末节软组织缺损的效果。方法 2001年至2008年,共修复拇指末节软组织缺损71例。分别应用交腹皮瓣、食指背侧岛状皮瓣、拇指桡背侧皮瓣、大鱼际桡侧逆行岛状瓣、游离趾腹皮瓣修复缺损,并进行对比研究。其中大鱼际桡侧逆行岛状瓣应用13例,皮瓣设计在大鱼际区桡侧,以拇指桡掌侧动脉为蒂,旋转点在指间关节以近。皮瓣面积最大4.1cm×2.8cm,最小2.2cm×1.5cm,10例行皮神经与指神经吻合。术后10d开始功能锻炼。进行随访,随访内容包括拇指的色泽、外形、质地、出汗情况及综合感觉,拇指指腹痛觉、触觉、两点辨别觉及运动功能等。结果术后随访12～18个月,以最后一次复查为准,大鱼际桡侧逆行岛状皮瓣的皮肤色泽、外形、质地、出汗及综合质地感觉均优于交腹皮瓣及食指背侧皮瓣,与拇指桡背侧皮瓣、趾腹游离皮瓣优良率相似。结论应用带血管神经蒂的大鱼际桡侧逆行岛状瓣修复拇指软组织缺损,操作简单,血供可靠,能恢复感觉,修复后功能及外形均满意。

Objective To explore the effect of greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defect.Methods From 2001 to 2008,71 cases distal thumb sofe tissue defect was repared. 13cases was used to greeter thenar palmar reversed island flap.The flap was devised at the greater thenar with pedicle of thumb radialpalmar artery.The rotation point was proximal to the interphalangeal joint.The flap ranged from4.1cm×2.8cm to 2.2cm×1.5cm connecting neurocutaneous and finger nerve for 10 cases and summarized after ten days the results of 71 patients whose data were completely acquired,according to the shapes,sweating sensory and motor functions etc.71 patients,by operative time,blood loss and comprehensive sense to compare.Results Were followed up for 12 to 18 months,Subject to final review,The shapes,sweating and sensory of the thumb pulp with greeter thenar palmar reversed island flap were excellent to Abdominal flap The index finger dorsal island flap,and similar to thumb at ulnar side island flap,greeter thenar palmar reversed island flap,the big toe.Conclusion The greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defect has advantages of simple performance and reliable blood supply and reconstruct its sensation.