带血管神经蒂的大鱼际近端皮瓣修复指腹缺损

Repair of pulp defect at the finger using approximate radial thenar flap with neurovascular pedicle

目的 介绍一种修复拇指指腹软组织缺损并重建感觉功能的新供区。方法 用带血管神经蒂大鱼际近端皮瓣修复拇指指腹软组织缺损 6例 ,其中 4例为逆行岛状皮瓣 ,2例为游离皮瓣。皮瓣最大切取面积为 4.0cm× 2 .5cm ,最小为 2 .5cm× 1 .5cm。术中在放大 6倍手术显微镜下 ,观察大鱼际近端皮肤的动脉 ,静脉 ,神经支配的来源、分支及血管吻合情况。结果 6例皮瓣全部成活。术后随访 9～ 1 8个月 ,伤指外形及皮肤色泽与健指相似 ,拇指指腹静止二点分辨觉 (S 2PD)为 6.6～ 8.1mm ,移动二点分辨别觉 (M 2PD)为 5.1～ 6.5mm。结论 带血管神经蒂大鱼际近端皮瓣是修复拇指指腹软组织缺损并能重建感觉功能的好供区。

Objective To introduce a new donor to repair soft tissue defect of the volar side of the thumb and reconstruct its sensation. Methods 6 cases with soft tissue defect of the thumb at palmar side were repaired by approximate radial thenar flap pedicled with superficial palmar branch of the radial artery and a cutaneous branch of the middle nerve, 4 cases for island flap, 2 cases for free flap. The area of the flap was between 2.5 cm × 1.5 cm and 4.0 cm × 2.5 cm. And we examined the vascular and neural supplies of the radial thenar area under 6 times microscope. Results All 6 cases of the surgical flaps were survived. Follow up was 9 ～ 18 months after operation. The appearance and color of the thumb were satisfactory. Satic and moving two point discriminations (2PD) were 6.6 ～ 8.1 mm and 5.1 ～ 6.5 mm. Conclusions The approximate radial thenar flap with neurovescular pedicle was a good donor to repair soft tissue defect of the volar side of the thumb and reconstruct its sensation.