改良示指背侧皮瓣联合示指固有伸肌腱一次性修复拇长伸肌腱及皮肤缺损

Advanced repair method of extensor pollicis longus muscle tendon and skin defect using index finger dorsal flap combined with extensor indicis proprius tendon

目的探讨改良示指背侧皮瓣联合示指固有伸肌腱一次性修复拇长伸肌腱及皮肤缺损的方法及临床疗效。方法选取2012年5月至2014年1月,我科收治的17例拇指指背侧皮肤缺损伴拇长伸肌腱部分缺失患者,均行改良的示指背侧皮瓣联合示指固有伸肌腱转移一次性修复术,通过观察皮瓣成活率、外形、皮瓣感觉和总主动活动(TAM)系统评定法评定疗效。结果本组17例患者手术顺利,可评价疗效。术后平均随访(15.3±5.1)个月,患者术后皮瓣全部成活,外形及感觉良好,拇指功能按照TAM系统评定方法评为优12例(70.6%)、良5例(29.4%)、中0例、差0例。结论改良示指背侧皮瓣联合示指固有伸肌腱转移可一次修复拇长伸肌腱及皮肤缺损,手术操作简捷,供区损伤小,随访效果好。

Objective To explore the clinical effectiveness of advanced repair method of extensor pollicis longus muscle tendon and skin defect using index finger dorsal flap combined with synchronous extensor indicis proprius tendon transferred surgery. Methods From May 2012 to January 2014,clinical data of 17 patients affected with thumb dorsal skin defect and extensor pollicis longus tendon partial deletion were retrospectively analyzed. Each of all 17 patients was performed with advanced repair method of index finger dorsal flap combined with synchronous extensor indicis proprius tendon transferred surgery. Survival rate of the flap,shape,sensation of the flaps,and total active movement （ TAM） system were used to evaluate the clinical effectiveness. Results All patients got surgery fa-vorably and could be used to evaluate the clinical effectiveness,which were followed up for 6 months to 2 years （mean 15. 3 months）. All of the flaps survived,which were in good state of shape and sensation. Thumb function in TAM system was 12 excellent and 5 good. Conclusion Advanced index finger dorsal flap combined with synchronous extensor indicis proprius tendon can be used for the repair of extensor pollicis longus muscle tendon and skin defect,which is easy performed,and have a smaller damage in donor site and a good clinical effectiveness in short-term follow up. The aforementioned method deserves to be popularized.