拇指背侧远端蒂皮神经营养血管皮瓣修复同指软组织缺损的临床研究

Applied research of thumb distally based dorsal neurovascular flap repair for soft tissue defect

目的：探讨拇指背侧远端蒂皮神经营养血管皮瓣（DTNF）修复同一拇指软组织缺损（STDT）的疗效。方法：以2011年12月至2012年12月在我院采用食指背侧皮神经营养血管皮瓣（SNF）修复治疗的STDT患者40例为对照组；以2013年1～12月采用拇指背侧DTNF修复治疗的STDT 患者40例为观察组。比较两组患者治疗后手的功能状态及感觉功能。结果：观察组STDT 患者手的功能状态、手部感觉功能均明显优于对照组（P＜0．05）。观察组术后12 d时出现1例DTNF表皮坏死，经补救后皮瓣复活。结论：拇指背侧DTNF修复法对STDT 的治疗效果优于食指背侧SNF修复法；术中应注意设计最优拇指背侧DTNF ，规范手术操作，保护DTNF的血管网，可进一步改善患者预后。

Objective：To investigate the efficacy of the thumb distally based dorsal neurovascular flap （DTNF） repair the soft tissue defect of thumb （STDT ） .Methods ：40 STDT patients repaired by the index finger dorsal skin neurocutaneous flap （SNF） therapy were set as control group .40 STDT patients repaired by DTNF ther‐apy were set as observation group .The hand functional status and sensory function were compared .Results ：The hand functional status and sensory function in observation group were significantly better than those in the control group （P〈0 .05） .1 case patient in the observation group DTNF epidermal necrosis after 12 d .Conclusion：Thumb dorsal DTNF therapy for treatment of STDT is better than the index finger dorsal SNF therapy .Clinicians should pay attention to the optimal design of thumb dorsal DTNF ,standardized surgical procedures ,protection of DTNF vascular network to further improve the prognosis of patients .