两种皮瓣修复拇指末节指腹缺损的效果比较

Repair of Distal Thumb Defect Refers to Two Types of Skin Flap

目的比较拇指桡背侧逆行岛状皮瓣和食指背侧顺行岛状皮瓣修复拇指末节指腹缺损。方汪2012年7月-2013年7月，应用拇指桡背侧逆行岛状皮瓣和食指背侧顺行岛状皮瓣修复拇指末节指腹缺勘18例，随机分为两组，拇指桡背例逆行岛状皮瓣组10例，食指背侧顺行岛状皮瓣组8例，术后对皮瓣的成活率拇指的功能恢复、供区的影响进行了比较研究。结果经11-32个月，平均20个月随访，18例皮瓣成活17例皮瓣血运、质地良好，仅1例食指背侧顺行岛状皮瓣术后5d皮瓣远端出现部分坏死；皮瓣感觉均恢复到S3，S：＋，其中拇指桡背侧皮瓣组S37例，S3＋3例，食指背侧皮瓣组S33例，S3＋5例。患者拇指再造功能评定为做12例（拇指桡背侧皮瓣组7例，食指背侧皮瓣组5例），良4例（两组各2例），差2例（两组各1例）。结论拇指桡背侧逆行岛状皮瓣修复拇指指腹缺损较食指背侧顺行岛状皮瓣外形美观，血供可靠，对供区影响更小，更适合作为修复拇指末节指腹缺损的选择。

Objective To compare the effect of repairing distal thumb defect with thumb radial dorsal retro- grade island skin flap and index finger dorsal anterograde island skin flap. Methods Eighteen cases of patients were cured with two kinds of flaps from 2012 July to 2013 July. They were randomly divided into two groups, thumb radial dor- sal retrograde flap group contains 10,while index finger dorsal anterograde flap group contains 8. Postoperative survival rate of skin flap, thumb function recover）, and the influence to donor site were compared. Results After 11 - 32 months, average 20 months follow-up, 17 in 18 cases survived and showed rich blood supply and good texture,while only one in- dex finger dorsal anterograde island skin flap was suffered with distal skin flap necrosis. The sensation of the flaps recov- ered to S3 ,S3 ＋. 7 thumb radial dorsal flaps recovered S3,3 cases $3 ＋. 3 index finger dorsal flaps recovered S3,5 cases S3 ＋. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Associa- tion,the excellent and good rate was 88.9%. Conclusion The appearance of thumb radial dorsal retrograde island skin flap is more beautiful, blood supply is more reliable, and the influence on the donor area is less. Thumb radial dorsal ret- rograde island skin flap is more suitable for the repair of pulp defect in thumb tip.