携带指动脉指背推进皮瓣修复指腹缺损

Dorsal digital advancement flaps vascularized with digital arteries for repair of finger pulp defect

目的探讨携带指动脉的指背岛状皮瓣推进转移修复指腹缺损的手术方法和临床效果。方法选择2007年10月-2011年7月收治的36例（43指）指腹软组织缺损患者，其中男25例（30指），女11例（13指）；年龄12—62岁，平均34．5岁。致伤原因：压砸伤19例（22指），挤压伤13例（16指），切割伤4例（5指）。示指11指，中指18指，环指9指，小指5指。创面均有骨外露，缺损面积最小1．2cm×1．0cm，最大2．6cm×2．0cm。应用携带指动脉的指背岛状皮瓣推进转移修复，并吻合指固有神经背侧支重建指腹感觉，供区植皮。结果36例（43指）皮瓣全部成活，33例（39指）获得随访，随访时问5—26个月，平均14．5个月。皮瓣外观满意，质地柔软，皮肤弹性好，伤指无疼痛，皮瓣的两点辨别觉达5～8mm，平均6．7mm。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24指，良13指，可2指，优良率为95％。结论携带指动脉的指背岛状皮瓣推进转移修复指腹缺损，术式操作简便、安全，术后效果满意，是修复指腹缺损较为理想的方法。

Objective To investigate the effect of dorsal digital island advancement flaps accom- panied with digital arteries in reconstruction of finger pulp defect. Methods The study enrolled 36 ca- ses （43 fingers） of pulp soft tissue defect treated from October 2007 to July 2011. There were 25 males （30 fingers） and 11 females（ 13 fingers）, at age of 12-62 years （ mean 34.5 years）. Causes of injury in- cluded crushing in 19 cases （16 fingers）, squeezing in 13 （16 fingers） and cutting in 4 （5 fingers）. The fingers involved were the index （11）, the middle （18）, the ring （9）, and the little （5）. All wounds revealed the exposed bone with defect area ranging from 1.2 cm × 1.0 cm to 2.6 cm ×2.0 cm. Dorsal digital island flaps accompanied with digital artery were used for finger reconstruction and sensation was restored by anastomosing to dorsal branch of digital nerve. Donor sites were closed using skin grafts. Results All flaps survived. Thirty-three cases （39 fingers） were followed up for 5-26 months （mean 14. 5 months）. The flaps revealed satisfactory appearance, soft texture and good elasticity. The injured fingers were pain-free. Two point discrimination was 5-8 mm （ mean 6.7 mm）. According to the upper limb function criteria formulated by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 24 fingers, good in 13 fingers, and fair in 2 fingers, with the excellence rate of 95 %. Con- clusion Dorsal digital advancement island flap vascularized with digital artery is relatively the best for finger pulp coverage, for the procedure is easy and safe, with satisfactory result.