同指掌侧脂筋膜瓣翻转修复指背皮肤及软组织缺损

The use of the homodigital volar adipofascial turnover flap for repairing of dorsal skin and soft tissue defects

目的探讨手指背侧皮肤及软组织缺损的修复方法及用同指掌侧脂筋膜瓣修复此类缺损的疗效。方法对12例手指背侧皮肤及软组织缺损患者,根据指背皮肤及软组织缺损情况,在同一指的掌侧,以一侧的指动脉为蒂,设计一旗状脂筋膜瓣。于脂筋膜瓣蒂侧切开皮肤,并向对侧游离,暴露出皮下脂筋膜组织,于皮肤蒂侧、屈指肌腱鞘浅层游离脂筋膜瓣,通过皮下隧道转至手指背侧创面,然后植皮,掌面皮肤原位缝合。随访时观察手指外形、运动及感觉情况。结果对全部病例随访1～14个月,平均8个月。筋膜瓣及植皮全部成活。3例行远侧指间关节融合;其余9例远侧指间关节活动范围10°～30°,平均20°。掌侧供区皮肤两点辨别觉2.5～4.0mm、平均3.0mm。患者对术后外形较满意。结论同指掌侧翻转脂筋膜瓣是修复手指背侧皮肤及软组织缺损的一种较好的方法。

Objective To investigate the method and results of repairing of the defect over the dorsal aspect of the finger using the volar adipofascial flap of the same finger. Methods The adipofascial flap in homodigital volar aspect were designed according to the dorsal skin and soft tissue defects of the same finger and the method was used in 12 patients. The skin from the side of the pedicle of the designed adipofascial flap was incised, and was turned over to the other side, exposing the adipofascial tissue and the superficial layer of the tendon sheath of flexor digital sublimis, then the adipofascial flap from the side of the pedicle of the skin was lifted, isolated and turned over to the dorsal aspect of the finger though a subcutaneous tunnel; the skin graft was carried out and the volar skin was sutured in situ. The patients were followed up; their finger sensation, motor function and the shape of the finger were examined. Results The period of the follow up was 1-14 months, 8 months in average. The adipofascial flap and the skin survived. The distal interdigital joint was fused in three patients, and in the others the range of movement was 10°-30°, 20° in average, the sensation of two point discrimination in donor side was 2.5-4.0 mm, 3.0 mm in average, and the patients were satisfied with the results. Conclusion The homodigital volar adipofascial turnover flap is a good method for the treatment of the distal dorsal skin and tissue defect of the same finger.