手背逆行筋膜皮瓣在手指皮肤软组织缺损修复中的应用

Application of dorsal retrograde fascia flap of hands in the operation of fingers skin and soft tissue defect repairation

目的:探讨利用手背逆行筋膜皮瓣修复在手指皮肤软组织缺损的临床效果,提高手术成功率。方法:对本院收治的35例患者38指,其中合并骨折11例,指神经损伤12例,肌腱断裂8例,缺损面积最小2.5cm×2.0cm,最大5.0cm×3.0cm,所有病例均应用手背逆行筋膜皮瓣修复进行修复。其中7例吻合皮瓣的皮神经和手指断端的指神经,重建指腹感觉。结果:本组35例,皮瓣面积最大为4.0cm×1.8cm,最小为1.5cm×1.2cm,蒂宽1.0～1.5cm。除2例皮瓣远端缺血、坏死,经处理后二期愈合外,其余筋膜皮瓣全部成活。随访1年,外观满意,手指伸屈功能恢复良好,指腹两点辨别觉4.0～8.0mm。结论:本方法具有保留手指长度、手部外形良好、皮瓣成活率高,手术操作简便,不牺牲主要血管,住院时间短等优点。

Objective Discussion on the use of hand reverse fascio-cutaneous flap in clinical effect of finger skin and soft tissue defect to improve the success rate of operation. Methods 35 cases including 38 fingers injury,together with 11 fractura,or 12 fingers＇ nerves injury, or 8 tendon rupture. The defect minimum area is 2.5cm ×2.0cm and the maximum area is 5.0cm ×3.0cm. These were treated with retrograde fascial flap to repaird. Seven cases of them, coincide the cutaneous nerve of skin flap with the broken fingers to reconstruct the finger pulp feeling of the patients. Results In these 35 cases, the maximum area of skin flap is 4.0cmxl .Scm, and the minimum area is 1.5cm×1.2cm.The width of the pedicle is 1.0-1.5cm.AII fascial flap of hands were survived,except 2 cases with ischemia and necrosis in the far-end of the flap after the treatment of secondary healing. One year follow-up, we were satisfied with the appearance of the fingers and the function of flexion and extension of the fingers. The sense of the two-point discrimination is 4.0N8.0mm. Conclusion The advantages of this method is obvious.The repairation has reserved finger length and kept hand in good shape. The survival rate is higher.The operation is simpler,without sacrifice of major arteries,and the hospitalization time is shorter.