同指螺旋岛状皮瓣修复指腹缺损

Repair of finger pulp defect with the homodigital spiral neurovascular island flap

目的:探讨同指螺旋岛状皮瓣修复指腹缺损的方法和临床疗效。方法:自2007年6月至2009年10月,采用以同指一侧指固有神经血管束为蒂螺旋岛状皮瓣向前推进修复指腹缺损16例16指,男12例,女4例;年龄18～49岁,平均37岁。机器挤伤11例,重物砸伤2例,车门挤伤1例,电锯伤2例。损伤指别:食指5例,中指9例,环指2例。均为全指腹缺损,缺损范围:1.6cm×1.2cm～2.5cm×1.7cm,指背供区植皮。结果:皮瓣全部成活,创面Ⅰ期愈合,全部病例均获随访,时间8～20个月,平均12个月,手指外形良好,皮瓣质地软,静止两点辨别觉为5～7mm,平均为5.1mm。按照手指总主动活动度评级标准(TAM),优7例,良8例,中1例。结论:采用同指螺旋岛状皮瓣修复指腹缺损,手术操作简便,可获得良好临床疗效。

Objective ： To investigate the method and clinical outcome of reconstructing large pulp defects of the fingertips with a homodigital neurovascular island flap. Methods：Form June 2007 to October 2009,16 patients with the defects of pulp were repaired by the spiral flap that was a homodigital neurovascular island flap with a unique spiral advancement and transposition design allowed pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. There were 12 males and 4 females with an average age of 37 years ranging from 18 to 49 years. The defect were caused by machine crush injury 11 cases,pressure injury by heavy objects in 2 cases,crush injury by door of car 1 case,injury by saw in 2 cases. The defect was located in the index finger in 5 cases,the middle finger in 9 cases,the ring finger in 2 cases. All injuries had large pulp defects averaging 1.6 cm （long）× 1.2 cm （wide） to 2.5 cm （long）× 1.7 cm （wide）. Short-term results for all patients were reviewed. Outcome measures included static 2-point discrimination, total active motion, and hypersensitivity or cold intolerance. Results ： All flaps achieved primary healing with no complications. Sensory recovery was excellent with an average 2-point discrimination of 5.1 mm. All patients were followed-up for 8 to 20 months （averaged 12 months ） with highly satisfactory with both aesthetic and functional outcome. There was no hypersensitivity or cold intolerance. According to the evaluation of total active motion （TAM） scales ,the results were excellent in 7 cases ,good in 8 cases （9 lesions） and fair in 1 case. Conclusion ：The spiral advancement-transposition flap is suitable for resurfacing large pulp defects with excellent short-term functional and aesthetic results and high patient satisfaction.