指动脉不同节段背侧皮支为蒂的V-Y推进皮瓣修复同指背皮肤缺损

APPLICATION OF V-Y ADVANCEMENT FLAP PEDICLED WITH DORSAL CUTANEOUS BRANCH OF DIGITAL ARTERY FOR SKIN DEFECT AT THE SAME DORSAL FINGER

目的探讨以指动脉不同节段背侧皮支为蒂的V-Y推进皮瓣修复同指指背皮肤缺损的临床效果。方法 2008年1月-2010年2月,收治15例不同节段指背皮肤软组织缺损患者。男9例,女6例;年龄15～72岁,平均43岁。电锯伤6例,压榨伤7例,指背结节切除后2例。远侧指间关节指背缺损2例,中节指背缺损6例,近节指背缺损7例。均伴肌腱、指骨外露,其中伴指骨骨折5例,肌腱损伤10例。创面缺损范围为0.8cm×0.5cm～1.4cm×1.0cm。受伤至手术时间为3～8h。术中对伴指骨骨折者,行骨折复位后克氏针内固定;伴肌腱损伤者,采用4-0肌腱缝线修复伸肌腱。采用1.2cm×0.8cm～2.5cm×1.0cm以指动脉不同节段背侧皮支为蒂的V-Y推进皮瓣修复同指指背缺损,供区直接缝合。结果术后皮瓣均顺利成活,供受区切口均Ⅰ期愈合。术后10例获随访,随访时间6个月～2年。皮瓣质地、外形良好,两点辨别觉为10～12mm。5例伴指骨者骨折X线片检查示术后5～8周,平均6周均达骨性愈合。末次随访时伴肌腱损伤者患指关节伸屈功能根据总主动活动度系统评定法评定:优8例,良1例,可1例,优良率90%。结论采用指动脉不同节段背侧皮支为蒂的V-Y推进皮瓣修复同指指背皮肤缺损操作简便、风险小,术后疗效、外形满意。

Objective To investigate the therapeutic effect of V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery for skin defect at the same dorsal finger.Methods Between January 2008 and February 2010,15 cases of skin defect at the same dorsal finger were treated.There were 9 males and 6 females,aged 15-72 years（mean,43 years）.Defect was caused by saw machine in 6 cases,machines crush in 7 cases,and cutting nodule in 2 cases.The locations were distal dorsal finger in 2 cases,middle dorsal finger in 6 cases,and proximal dorsal finger in 7 cases.All cases complicated by exposure of tendon and bone.The size of defect ranged from 0.8 cm × 0.5 cm to 1.4 cm × 1.0 cm.The interval between injury and operation was 3-8 hours.All fingers were treated by V-Y advancement flap from the dorsal cutaneous branch of digital artery,which size was 1.2 cm × 0.8 cm-2.5 cm × 1.0 cm,and the donor site was directly sutured.Fracture reduction and Kirschner wire for internal fixation were performed in the patients with fracture;extensor tendon was repaired with 4-0 thread in the patients with tendon injury.Results All flaps survived completely.The incisions of donor and recipient sites healed by first intention.Ten cases were followed up 6 months to 2 years after operation.The flaps had good texture,color,and appearance;2-point discrimination of the V-Y flap was 10-12 mm.X-ray examination showed that all finger fractures healed successfully in 5 cases,with an average bone union time of 6 weeks（range,5-8 weeks）.According to the criteria for function assessment by total active motion,the results were excellent in 8 cases,good in 1,and fair in 1 with an excellent and good rate of 90%.Conclusion It is an ideal method to treat skin defect at the same dorsal finger with V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery.