指固有血管神经束背侧支顺行岛状皮瓣修复指端缺损

Repair of the fingertip defect with anterograde island flap with the proper neurovascular bundles of the dorsal branches

目的探讨指固有血管神经束背侧支顺行岛状皮瓣修复指远端皮肤缺损方法的疗效和优越性。方法2011年2月至2012年12月，对31例31指指端皮肤缺损患者采用指固有血管神经束背侧支顺行岛状皮瓣修复，手术于指远侧指间关节处尺背侧或桡背侧设计皮瓣，皮瓣以指固有动脉背侧支为血供，并携带指固有神经背侧支重建手指感觉，供区于上臂取全厚皮片游离植皮覆盖。结果术后31指创面修复皮瓣及供区植皮均存活。随访3～6个月，皮瓣外形理想，质地良好，感觉恢复优良，两点分辨觉平均为3．49～6．43mm，患指远指间关节活动度平均为53．94°～73．72°，近端指问关节活动度平均为77．31°～101．89°。结论采用指固有血管神经束背侧支顺行岛状皮瓣修复指远端皮肤缺损，手术操作简单，不牺牲知名动脉、神经，供区损伤小，皮瓣血流符合生理，血供可靠，并能重建感觉且不影响指问关节活动度，是指端缺损一种理想的手术修复方法。

Objective To observe the treatment outcome and superiority of using anterograde island flap with the proper ueurovascular bundles of dorsal branches for the fingertip defect. Methods From February, 2011 and December, 2012, anterograde island flaps were used to cover the fingertip defects in 31 fingers in 31 patients. The flap was designed on the dorsal ulnar or dorsal radial side of the distal interphalangeal joint with dorsal branches of the proper digital artery and accompanying nerves to reestablish the sensation in the distal phalanges. Donor areas were covered by full- thickness skin graft from upper arm. Results All flaps survived completely. Patient follow- ups ranged from 3-6 months. The flaps had a good appearance, texture and blood circulation. The average static two-point discrimination and moving two-point discrimination of the flaps were 3.49 mm and 6. 43 mm, respectively. The mean range of motion of the distal interphalangeal, and proximal interphalangeal joints of the donor fingers ranged from 53.94°-73.72°, and 77.31°- 101.89°, respectively. Conclusion The anterograde island flap with the dorsal branches of the proper neurovascular bundles is useful for restoration of sensation on the fingertip. The main advantages of the flap include their simplicity; the reliable blood supply; the minor damage in donor site; and avoidance of damage to the well-known arteries and nerves.