指固有动脉串联岛状皮瓣修复相邻指体指端套脱伤

Digital artery serial reverse island flaps for repairing fingertip degloving injuries of adjacent fingers

目的研究采用指固有动脉串联逆行岛状皮瓣修复相邻指体指端套脱伤的临床疗效。方法2009年3月至2011年5月，我院采用指固有动脉串联逆行岛状皮瓣修复相邻指体指端套脱伤11例。示指5例，中指3例，环指2例，小指1例。皮肤缺损面积为3．0cm×2．2cm～5．5cm×4．5cm。结果本组1例术中皮瓣在游离过程中即发生血管痉挛，经局部滴注罂粟碱及生理盐水热敷后痉挛解除；2例皮瓣术后出现水泡，1周后消失；其余皮瓣均顺利存活。术后随访6～24个月，平均12个月。皮瓣外形、质地均良好，恢复部分感觉功能。参照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6例，良4例，可1例；优良率90．9％。结论指固有动脉串联逆行岛状皮瓣修复指端套脱伤，手术操作简便，疗效满意。

Objective To investigate the effectiveness of using digital artery tandem reverse island flaps to repair fingertip degloving injuries of the adjacent fingers. Methods Between March 2009 and May 2011, 11 cases of degloving injuries of the fingertip were treated using this procedure. Among these cases 5 involved the index finger, 3 involved the middle finger, 2 involved the ring finger and 1 involved the little finger. The sizes of skin and soft tissue defect ranged from 3.0 cm x 2.2 cm to 5.5 cm x 4.5 cm. The two island flaps were harvested along the same digital artery course and transferred to cover defects of the fingertip of adjacent fingers. Results Vascular spasm occurred in 1 case during flap harvesting which was alleviated by topical application of papaverine and warm saline. Postoperative blister appeared in 2 cases but disappeared after one week. The other flaps survived uneventfully and the wounds healed by first intention. The follow-up period ranged from 6 to 24 months, being 12 months on average. All flaps presented the satisfactory shape and texture and recovered some sensation. The flexion and extension function of wounded fingers recovered to normal. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of Chinese Medical Association, the outcomes were graded as excellent in 6 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 90.9%. Conclusion The digital artery tandem reverse island flaps for repairing fingertip degloving injury is a simple and effective procedure.