静脉动脉化逆行岛状皮瓣修复指腹缺损

The clinical application of three reversed island flap in superficial palmar digital veins aterilization

目的介绍指掌侧浅静脉动脉化含指神经、指神经指背支或指背神经、指神经掌皮支，三种逆行岛状皮瓣修复远节指腹缺损的临床应用。方法2001年2月-2010年8月，对50例60指指腹缺损患者，分A，B，C三组。A组15例15指采用指神经的指掌侧浅静脉动脉化修复；B组20例26指采用指神经指背支（或指背神经）的指掌侧浅静脉动脉化修复；C组15例19指采用指神经掌皮支的指掌侧浅静脉动脉化修复。皮瓣切取面积：1．5cm×2．0cm^3．0cm×3．5cm。结果除B组2块皮瓣坏死外。余均成活。术后随访6个月～2年，指腹外形佳，轮廓近似正常。指腹饱满而不臃肿，质地柔软，供血充分，有排汗功能，无色素沉着。2PD（两点辨别觉）：A组5．0～7．0mm，B组7．0～9．0mm，C组6．0～7．5mm；感觉测定：A组S3＋～S4＋。B组S2～S3＋，C组S3～S4。结论应用接合指神经、指神经指背支（指背神经）、指神经掌皮支的指掌侧浅静脉动脉化三种逆行岛状皮瓣，术后效果好，供区勿需牺牲指动脉，损伤小，是修复末节指腹缺损的可行新方法，值得临床推广。

Objective To introduce the clinical outcomes of pulp defect with three reversed island flap in superficial palmar digital veins aterilization, including digital nerves, dorsal digital nerves and ramus cutaneus volaris digital nerves. Methods Treated between February 2001 to August 2010, 50 patients （60 fingers） with pulp defect were randomly divided into group A, B and C. 15 cases （15 fingers） from group A were treated with superficial palmar digital veins aterilization in digital nerves; 20 cases （26 fingers） from group B in dorsal digital nerves;15 cases （19 fingers） from groupC in ramus cutaneus volaris digital nerves. The area of the flaps ranged from 1.5cm×2.0cm to 3.0cm×3.5cm. Results All cases survived successfully except two flaps being necrosis in group B. All pulps presented with good shape, curved profile similar to normal, full but not bloated, solf, well blood supply, good sweating function and no pigmentation in a 6~ 24month postoperative follow-up. 2 point discrimination was 5.0~7.0mm in group A; 7.0~9.0mm in group B; 6.0-7.5mm in group C. Sensory determination value was S3＋-S4＋ in group A; S2-S 3＋ in group B;S3 ~S4 in group C. Conclusion The clinical application of three reversed island flap in superficial palmar digital veins aterilization, including digital nerves, dorsal digital nerves and ramus cutaneus volaris digital nerves was well beneficial to pulp defect patients with good results after surgery, small damage and no need to sacrifice finger arterial supply areas. It is worth being popularized.