改良示指背侧岛状皮瓣一期修复拇指指端缺损

IMPROVED INDEX FINGER DORSAL ISLAND FLAP FOR PRIMARY REPAIR OF THUMB TIP INJURY

目的探讨改良示指背侧岛状皮瓣一期修复拇指指端缺损的可行性。方法 2009年1月-2010年2月,收治23例拇指指端缺损患者。男17例,女6例;年龄21～47岁,平均27.5岁。致伤原因:机械伤18例,重物砸伤5例。受伤至手术时间为2.5～5.0h,平均3.5h。尺掌侧缺损5例,尺背侧缺损6例,桡掌侧缺损8例,桡背侧缺损4例。23例均伴拇指末节指骨外露。创面缺损范围2.1cm×1.8cm～2.8cm×2.5cm。根据拇指末节软组织缺损情况,应用改良皮瓣设计使蒂部关键点前移的示指背侧岛状皮瓣修复缺损,皮瓣切取范围2.3cm×2.0cm～3.0cm×2.7cm。供区植皮修复。结果术后皮瓣及供区植皮均成活,切口Ⅰ期愈合。患者均获随访,随访时间6～12个月,平均6.4个月。皮瓣外形、质地良好。末次随访时,皮瓣感觉恢复达S3+18例,S32例,S23例;两点辨别觉为3～4mm。拇指对掌、对指功能正常,虎口区未发生挛缩。供区示指掌指关节屈伸活动正常。结论改良的示指背侧岛状皮瓣蒂部旋转点前移达10mm以上,能满足拇指指端缺损修复的需要,且皮瓣血供良好,成活率高。

Objective To study the improved index finger dorsal island flap for primary repair of thumb tip injury.Methods Between January 2009 and February 2010,23 patients with thumb tip injury were treated.There were 17 males and 6 females,aged 21-47 years（mean,27.5 years）.The causes of injury were mechanical injury in 18 cases and heavy crushing injury in 5 cases.The time from injury to operation was 2.5-5.0 hours（mean,3.5 hours）.The defect locations included ulnar palmar defect in 5 cases,dorsal foot defect in 6 cases,radial palmar defect in 8 cases,and radial dorsal defect in 4 cases.All patients complicated by exposure of the thumb distal phalanx.The wound area varied from 2.1 cm × 1.8 cm to 2.8 cm × 2.5 cm.According to distal soft tissue defect of thumb,a modified index finger dorsal island flap was designed,key point of which was moved forward,and defects were repaired with the flaps.The size of flap was 2.3 cm × 2.0 cm to 3.0 cm × 2.7 cm.The donor sites were repaired with skin graft.Results All the flaps and grafts survived after operation and the wounds healed by first intention.All patients were followed up 6-12 months with an average of 6.4 months.The appearance and texture of the flaps were excellent.At last follow-up,the sensation of the flaps recovered to S3＋ in 18 cases,to S3 in 2 cases,and to S2 in 3 cases.The two-point discrimination was 3-4 mm.Thumb opposition function was normal without contracture at the first web space.The skin graft at the donor site survived completely,and the metacarpophalangeal joint at donor site had the flexion and extension function.Conclusion Using a modified index finger dorsal island flap for primary repair thumb tip injury is a simple operation,which has good blood supply and high survival rate.When the pedicle flap rotation point is moved forward 10 mm or more,it can meet the needs of repairing thumb tip defect.