指固有神经背侧支营养血管岛状皮瓣修复指端缺损

Distally based neurovascular fasciocutaneous island flap of the proper digital nerve dorsal branch to repair fingertip defects

目的评价带指固有神经背侧支营养血管远端蒂岛状筋膜皮瓣修复指端缺损的临床疗效。方法2010年7月至2012年1月，对在我院住院治疗的23例末节指腹及指背皮肤软组织缺损的患者，采用带指固有神经背侧支营养血管远端蒂岛状筋膜皮瓣修复。结果术后23例皮瓣全部存活。21例（2例失访）获得3～15个月的随访，平均6．7个月，1例修复中指末节指腹创面，后期因皮瓣收缩，指骨外露，再次行残端修整术。20例皮瓣厚薄适宜、质地柔软、色泽良好，供区无肌腱粘连和切151瘢痕挛缩导致的关节活动障碍。按中华医学会手外科学会上肢部分功能评定试用标准评定，优良率为87％。结论带指固有神经背侧支营养血管远端蒂岛状筋膜皮瓣修复指端缺损，外观满意，功能良好。

Objective To analyze the clinical outcomes of treating fingertip defects with distally based neurovascular fasciocutaneons island flap of the proper digital nerve dorsal branch. Methods Twenty-three cases with soft tissue defects in the pulp or dorsum of the fingertip were treated by the distally based neurovascular fasciocutaneous island flap of the proper digital nerve dorsal branch from July 2010 to January 2012. Results All 23 flaps survived completely. Twenty-one cases were follow-up from 3 to 15 months with an average of 6.7 months postoperatively, while 2 cases were lost. One flap for repair of the middle finger pulp shrank postoperatively and the bone was exposed. Stump revision was done. The other 20 flaps were with proper thickness, supple texture and good color. There was no donor site tendon adhesion or scar retraction that impairs joint movement. According to the criteria for functional assessment of the upper extremity issued by the Chinese Hand Surgery Society, the overall good-excellent rate was 87%. Conclusion Distally based neurovascular fasciocutaneous island flap of the proper digital nerve dorsal branch is a satisfactory method for treatment of fingertip defects.