手指皮肤软组织缺损显微外科修复的临床观察

The clinical observation of microsurgical repair of finger skin and soft tissue defect

目的 观察应用两种方法修复手指皮肤软组织缺损的临床疗效. 方法 2011年1月—2013年8月,对35例（46指）手指皮肤软组织缺损的患者分别采用掌背动脉穿支营养皮瓣或改良游离第1趾蹼皮瓣修复. 皮瓣面积：1.0 cm×2.5 cm-3.5 cm×6.0 cm. 结果 本组35例（46指）皮瓣均成活,其中1例掌背动脉穿支营养皮瓣远端出现表浅坏死,经换药1周后愈合. 1例改良游离第1趾蹼皮瓣术后出现静脉危象,给予换药,解除局部压迫,静脉滴注解痉药物等处理后血运恢复正常. 28例（34指）获得了6-24个月随访,平均14个月,皮瓣外形及色泽满意,无明显臃肿,两点辨别觉恢复至4.0-8.0 mm,平均5.7 mm,手功能TAM法测定：优15例,良9例,可4例,优良率达85.7%. 结论 两种方法修复手指皮肤软组织缺损各有优缺点,针对不同的病例应从多方面权衡利弊,确定个体化的手术方案,以达到最佳的修复效果.

Objective To observe the clinical curative effect of tow kinds of methods on repairing the defect of skin and soft tissue. Methods We repaired 35 cases （46 fingers） with the skin and soft tissue defect by using the nutrition skin flaps of dorsal metacarpal artery perforator or the improvement of free flaps of the first toe web. The maximum area of flaps was 3.5 cm ×6.0 cm, the minimum is 1.0 cm ×2.5 cm. Results One case of the nutrition flaps of dorsal metacarpal artery appeared distal superficial necrosis and the wound healed after changing dressing. One case of the improvement of free flaps of the toe web appeared vascular crisis after operation. And the blood supplement returned to normal after changing dressing, removing partial pressure and intravenous dripping the papaverine injection. 28 cases （34 fingers） of them received follow-up from 6 months to 24 months, the average of 14 months. All those follow-up patients＆#39; flaps were not only good in shape and color but also no swelling. The two-point discrimination returned to 4.0 mm-8.0 mm, the average of 5.7mm. Evaluaed by the hand function TAM： 15 patients reached to the excellent level, 9 patients reached to the better level and 4 reached to the good level,the excellent rate was 85.7%. Conclusion The two methods have their advantages and disadvantages in repairing the defect of finger skin and soft tissue. For obtaining the best effect of repairing wound and the maximum patient＆#39;s interests, so we should weigh fully the advantages and disadvantages in different cases and make sure the individuation operation scheme.