同指两叶皮瓣瓦合修复手指远节脱套伤

REPAIRING DEGLOVING INJURY OF DISTAL PHALANX WITH HOMODIGITAL BILOBED FLAPS TILED

目的探讨利用同指同侧带蒂双叶皮瓣瓦合修复指远节脱套伤的方法与临床疗效。方法 2008年4月-2011年6月,收治40例40指机械伤致手指远节脱套伤。男30例,女10例;年龄18～56岁,平均30岁。伤后至手术时间为1～5 h,平均2.5 h。损伤指别:示指13例,中指11例,环指9例,小指7例。缺损范围:远节1/2软组织全脱套3例,远节2/3软组织全脱套20例,远节3/4软组织全脱套17例。创面缺损范围3.0 cm×2.0 cm～5.5 cm×3.8 cm,伴轻至重度污染,肌腱与指骨外露,指骨骨折5例,肌腱止点均未见断裂。采用指动脉终末背侧支岛状皮瓣与指动脉岛状皮瓣瓦合修复14例,指动脉终末背侧支岛状皮瓣与指动脉近节背侧支岛状皮瓣瓦合修复18例,指动脉终末背侧支岛状皮瓣与指掌侧浅静脉动脉化岛状皮瓣瓦合修复8例。上叶皮瓣切取范围2.0 cm×1.5 cm～2.6 cm×2.2 cm,下叶皮瓣切取范围2.5 cm×2.0 cm～3.5 cm×2.5 cm。供区均植皮修复。结果术后发生皮瓣水疱13例,血管危象3例,均经对症处理后愈合。其余皮瓣及植皮均成活,创面Ⅰ期愈合38例,Ⅱ期愈合2例。术后30例获随访,随访时间8～20个月,平均10.6个月。皮瓣外形饱满,质地柔软,指端无触痛。于术后4～6周上叶皮瓣恢复保护性感觉,术后12～15个月24例下叶皮瓣两点辨别觉6.0～10.0 mm。依据1975年参照美国手外科学会推荐的手指总主动活动度(TAM)系统评定方法评定:优27指,良2指,可1指,优良率96.7%。结论利用同指同侧带蒂双叶皮瓣瓦合修复指远节脱套伤手术操作简便、可自由掌控损伤、配套合理、疗效满意,是一种较好的手术方法。

Objective homodigital bilobed flaps tiled. To study the methods and effectiveness of repairing degloving injury of the distal phalanx with Methods Between April 2008 and June 2011, 40 patients （40 fingers） with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years （mean, 30 years）. The time from injury to operation was 1-5 hours （mean, 2.5 hours）. Affected fingers included index in 13 cases, middle finger in 11 cases, ring finger in 9 cases, and little finger in 7 cases. The defect area ranged from 3.0 cm×2.0 cm to 5.5 cm×3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arterilization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm ×1.5 cm to 2.6 cm ×2.2 cm and the area of the next leaf flaps ranged from 2.5 cm ×2.0 cm to 3.5 cm ×2.5 cm. The donor sites were covered with free flaps. Results Flap blister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement （TAM） evaluation system introduced by the American Society for Surgery of the Hand in 1975, the results were excellent in 27 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 96.7%. Conclusion The homodigital bilobed flaps tiled for degloving injury of the distal phalanx is simple and easy- to-operate with less injury.