缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损

Repair of fingertip defect with proper digital artery lateral cutaneous branch-chain flap accompanied with dorsal digital nerve or dorsal branch of proper digital nerve coaptation

目的探讨缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损的疗效。方法2008年12月至2009年11月，对24例26指指远端皮肤缺损患者，以指固有动脉背侧支形成的血管链为血供，于近节指体侧方设计皮瓣，皮瓣轴线为指体侧方中线，皮瓣蒂宽0．8-1．0cm，皮瓣转折点为中节指体中远端，逆行转移修复指远端皮肤缺损，皮瓣携带指固有神经背侧支或指背神经与创面指神经断端进行缝合修复，重建手指感觉。结果术后26指皮瓣均存活。随访时间为6～8个月，皮瓣外形理想，质地良好，感觉恢复优良，两点分辨觉为4—8mm，患指指间关节平均活动度恢复优良。结论采用缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损，操作简单，血供可靠，不牺牲指固有动脉、神经，供区损伤小，术后并发症少，并能重建感觉，是一种理想的手术修复方法。

Objective To explore the effect of using proper digital artery lateral cutaneous branch-chain flap with dorsal digital nerves or dorsal branch of proper digital nerve for repairing of fingertip defect. Methods From December 2008 to November 2009, 24 cases （26 digits） of finge^p defect were treated with proper digital artery lateral cutaneous branch-chain flap. The flap was designed on the lateral side of the proximal phalanx of the injured finger with its long axis running on the lateral midline of the finger. The vascular pediele was 0.8 to 1.0 cm wide. The pivot point was at the distal 1/3 of the middle phalanx upon which the flap was reversed to repair the defect of the fingertip. The dorsal digital nerve or dorsal branch of proper digital nerve was included in the flap and coapted with the nerve in the wound to reconstruct sensation of the injured finger. Remtlts All 26 flaps survived. Postoperative follow-up period was 6 to 8 months. All these flaps recovered with satisfying appearance and quality, excellent sensation with 4 to 8 nan two-point discrimination. ROM of the interphalangeal joint of the injured finger was good. Conclusion Proper digital artery lateral cutaneous branch- chain flap transfer with nerve coaptation is an ideal method for repairing fingertip defect. The surgery is simple. Reliable blood supply can be achieved without sacrificing the proper digital artery. Coaptation of the nerve restores sensation at the fingertip. There is minor donor site damage and very few complications.