第一掌背动脉皮瓣I期修复拇指皮肤缺损合并神经缺损

One stage repair of soft tissue and nerve defect of thumb with island flap of first dorsal metacarpal artery

目的探讨第一掌背动脉皮瓣携带指神经背侧支I期修复拇指皮肤缺损合并神经缺损的手术方法和临床效果。方法对14例拇指皮肤缺损伴一侧或双侧神经断裂缺损患者，应用携带示指固有神经背侧支的第一掌背动脉岛状皮瓣修复，重建手指感觉。皮肤缺损最大面积为52mm×32mm，最小为10mm×8mm。神经缺损长度9—22mm。结果14例皮瓣全部成活，随访6～35个月，拇指功能及外观恢复满意，伤侧指腹感觉恢复s3＋，两点辨别觉恢复4～7mm，供区无瘢痕挛缩或感觉障碍等并发症。结论第一掌背动脉岛状皮瓣携带指固有神经背侧支修复拇指皮肤缺损合并神经缺损，能同时完成皮肤覆盖和神经缺损的修复，术后效果满意，是治疗拇指皮肤合并神经缺损并重建感觉较为理想的方法。

Objective To discuss the treatment and clinical efficacy of repair of soft tissue and nerve defect of thumb with island flap of first dorsal metacarpal artery based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve. Methods The skin and nerve defect in 14 thumbs were repaired by dorsal island flap of index fingers based on the first dorsal metacarpal artery car- rying dorsal branch graft of digital proper nerve. The size of skin defect ranged from 52 mm x 32 mm to 10 mm x 8 ram. The length of the nerve defect ranged from 9 mm to 22 ram. Results The average follow- up was 6-35 months. All 14 flaps survived with satisfactory appearance and function. The injured side of thumb pulp sensation recovered $3 ＋ and the injured two-point discrimination ranged from 4 mm to 7 mm. No scar contracture or sensory dysfunction complication were observed in the donor sites. Conclusions The repair of soft tissue and nerve defect of thumb with dorsal island flap of index finger based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve is recommendable, since it can obtain satisfactory clinical efficacy and be easily and conveniently performed.