掌背皮神经营养血管筋膜蒂皮瓣修复拇指皮肤软组织缺损

Repair of skin and soft tissue defects of the thumb with neurofasciocutaneous flap on dorsal part of hand

目的 探讨掌背皮神经营养血管筋膜蒂逆行岛状皮瓣修复拇指皮肤、软组织缺损的临床疗效.方法 采用皮神经营养血管筋膜蒂逆行岛状皮瓣修复拇指皮肤软组织缺损32例.以第一掌骨背侧皮神经为轴线,设计并切取筋膜蒂皮瓣,将皮瓣逆行转移修复拇指皮肤软组织缺损;供区直接缝合或游离植皮覆盖创面.结果 本组共32例患者.30例皮瓣Ⅰ期修复,其中6例术后出现表皮下淤血及水泡,2例皮瓣远端边缘部分表浅坏死,均经换药处理后愈合,皮瓣血运良好.随访2～12个月,皮瓣弹性、质地良好,外形饱满.皮瓣两点辨别觉：Ⅰ期吻合神经者为6～11 mm,未吻合神经者为8～ 18 mm.结论 应用掌背皮神经营养血管筋膜蒂逆行岛状皮瓣修复拇指皮肤软组织缺损,是一种简单、成活率高、疗效满意的手术方法.

Objective To investigate the clinical effect of repairing the thumb skin and soft tissue defects with neurofasciocutaneous flap on dorsal part of hand. Methods Thirty-two cases with skin and soft tissue defects of the thumb were treated with neurofasciocutaneous flap on dorsal part of hand. The neurofasciocutaneous flap was designed and harvested in the first dorsal metacarpal cutaneous nerve axis, and was transferred to repair the thumb skin and soft tissue defects. The donor sites were sutured directly or covered with free skin grafting. Results The flaps in 30 cases survived primarily which 6 flaps were with vacuoles or congestion, 2 flaps occurred superficial necrosis of distal edge which were healed after dressing changes with good blood supply. The followed-up were performed for 2 to 12 months, the flaps showed good elasticity, texture and satisfactory appearances. The sensation of differentiation between two points on the flaps ： with nerve anastomosis covered 6 to 11 mm, without nerve anastomosis covered 8 to 18 mm. Conclusion Neurofasciocutaneous flap on dorsal part of hand is a simple operation to repair skin and soft tissue defects of the thumb with high survival rate and satisfactory effects.