改良指动脉岛状皮瓣修复同指中远节创面

Application of modified digital artery island flap for repair of the middle and distal segment wounds of the same finger

目的 总结应用中节干骺支为蒂的改良指动脉岛状皮瓣修复同指第二掌侧吻合支损伤的中远节创面的疗效。方法 自2014年8月至2017年3月收治11例同指第二掌侧吻合支损伤的中远节皮肤软组织缺损或残端创面病例,应用中节干骺支为蒂的改良指动脉岛状皮瓣修复,皮瓣指背神经与对侧指神经缝合重建皮瓣感觉,供区游离植皮。结果 术后皮瓣及植皮均顺利存活。随访6~18个月,皮瓣质地柔软,外形无臃肿。两点分辨觉7~11mm。CISS(Cold Intolerance Severity Score)问卷评定手指寒冷耐受情况,平均21分(5~39分),其中轻度不耐寒10指,中度不耐寒1指。采用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8例,良2例,可1例。结论 应用中节干骺支为蒂的改良指动脉岛状皮瓣修复同指第二掌侧吻合支损伤的中远节创面,手术操作简便,血供安全可靠,感觉恢复较好。

Objective To investigate the clinical outcomes of modified digital artery island flap pedicled with metaphysis branch of the middle phalanx for repair of the middle and distal segment wounds of the same finger with the second palmar anastomotic branch injury.Methods From August2014to March2017,11cases of soft tissue defects with the second palmar anastomotic branch injury were treated with modified digital artery island flap pedicled with metaphysis branch of the middle phalanx.The dorsal digital nerve of the flap was sutured to the contralateral digital nerve to restore flap sensation.The donor site was covered with free skin graft.Results All the flaps and skin graft survived completely.All the patients were follow-up from6to18months.The flaps had good appearance and supple texture.The two-point discrimination was7to11mm.The Cold Intolerance Severity Score(CISS)ranged from5to39 with an average of2I.Ten fingers had mild cold intolerance,while 1 finger had moderate cold intolerance. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,the results were rated as excellent in8cases,good in2cases,and fair in 1case.Conclusion The application of modified digital artery island flap pedicled with metaphysis branch of the middle phalanx is a simple method with satisfactory sensory recovery and reliable blood supply for repair of the middle and distal segment wounds of the same finger with the second palmar anastomotic branch injury.