中环指相邻侧岛状皮瓣瓦合修复拇指指端脱套伤

Adjacent island flaps of middle and ring finger for repairing degloved injuries of the fingertip of thumb

目的总结采用同一血管蒂的中指尺侧和环指桡侧指动脉岛状皮瓣瓦合修复拇指指端脱套伤的手术方法和临床疗效。方法2008年9月-2012年7月．采用同一血管蒂的中指尺侧和环指桡侧指动脉岛状皮瓣瓦合修复拇指指端脱套伤8例。左手拇指3例，右手5例。皮肤缺损范围为4．0cm×3．2cm～7．2cm×5．5cm。伤后至入院时间为20min-7h，平均3．5h。本组中指皮瓣切取范围为2．5cm×2．2cm-4．2cm×3．0cm，环指皮瓣为2．0cmv1．5cm-3．5cm×2．8cm。供区取中厚皮片游离移植修复，打包加压包扎。结果本组皮瓣均顺利成活，切口及供区植皮均一期愈合。术后随访6～18个月，平均12个月。皮瓣外形、质地均良好，恢复保护性感觉，患指屈伸功能正常。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4例，良3例，可1例．优良率为87．5％。供指外形及功能无影响。结论采用同一血管蒂的中指尺侧和环指桡侧指动脉岛状皮瓣瓦合修复拇指指端脱套伤，手术操作简便，疗效满意。

Objective To investigate the surgery method and effection of adjacent island flaps of ulnaris middle finger and radialis ring finger with the same artery for repairing degloved injuries of the fingertip of thumb. Methods Between September 2008 and July 2012, 8 cases with degloved injuries of the fingertip of thumb were treated with ulnaris middle finger and radialis ring finger island flaps, there were 3 cases on the left, 5 cases on the right. The size of skin and soft tissue defect ranged from 4.0 cm× 3.2 cm to 7.2 cm ×5.5 cm. The average time from injury to surgery was 3.5 hours （ranged 20 minutes-7 hour）. The size of middle finger island flap ranged from 2.5 cm ×2.2 cm to 4.2 cm ×3.0 cm and the size of ring finger island flap ranged from 2.0 cm × 1.5 cm to 3.5 cm ×2.8 cm. The free grafts were used to repair the donor sites. Results All of the 8 flaps and the wounds healed by first intention. The followed-up period ranged from 6 to 18 months average （12 months）. All flaps presented the satisfactory appearance and texture,and the flexion and extension function of wounded fingers recovered to normal level, and recovered protective feeling, according to the functional assessment criteria of upper limb issued by the hand surgery branch of chinese medical association, among the 8 cases, there were excellent in 4 cases, good in 3, and fair in 1, with an excellent and good rate of 87.5%. Conclusion It is a simple and effective method, that using adjacent island flaps of ulnaris middle finger and radialis ring finger with the same artery for repairing degloved injuries of the fingertip of thumb.