双重血供拇指尺侧阶梯递进式皮瓣修复拇指Ⅰ、Ⅱ度斜形创面

Double blood supply of ulnar-sided thumb ladder progressive flap for repair of grade Ⅰ and Ⅱ thumb oblique wound

目的探讨拇指尺侧双重血供的阶梯递进式皮瓣修复拇指Ⅰ、Ⅱ度斜形创面的临床应用与疗效。方法选择2009年10月-2013年10月修复拇指指端Ⅰ、Ⅱ度缺损患者24例，其中男12例，女12例；年龄10-40岁，平均30岁。致伤原因：机器绞伤8例，机器切割伤6例，锐器切割伤6例，重物砸伤4例。拇指Ⅰ度缺损12例，Ⅱ度缺损12例。均采用双重血供拇指尺侧阶梯递进式皮瓣修复拇指Ⅰ、Ⅱ度斜形创面，皮瓣切取范围为1．0cm×3．0cm～1．5cm×3．5cm。本组皮瓣推移距离1．5-2．5cm。供瓣区直接缝合。观察创面愈合情况、皮瓣色泽及肿胀程度；检测皮瓣温度。按中华医学会手外科学会上肢部分功能评定试用标准评定手指功能。结果术后皮瓣全部成活，指端有保护性感觉，创面均Ⅰ期愈合。术后2例远侧指间关节僵硬，经康复锻炼后恢复正常功能。患者均获随访，时间1-36个月，平均20个月。皮瓣色泽及皮温同正常皮肤，质地良好，指腹饱满，拇指功能恢复满意。手指功能评定：优22例，良2例。结论双重血供拇指尺侧阶梯递进式皮瓣修复拇指Ⅰ、Ⅱ度斜形创面与重建指腹，操作简便，血供可靠，皮瓣修复效果好，可最大限度保留手指长度与功能。

Objective To investigate the clinical application and effecacy of ulnar-sided thumb ladder progressive flap in repairing grade Ⅰ and Ⅱ thumb oblique wound. Methods Between October 2009 and October 2013, ulnar-sided thumb ladder progressive flap with double blood supply was transferred to cover the grade Ⅰ and Ⅱ thumb oblique wound in 24 patients （ 12 males and 12 females）. Mean age was 30 years （range, 10-40 years ）. Mechanism of injury was machine twist injury in 8 patients, machine cutting injury in 6, sharp weapon injury in 6 and injury by a heavy object in 4. Twelve patients had grade Ⅰ defect and twelve patients grade Ⅱ defect. Flap ranged in size from 1.0 cm × 3.0 cm to 1.5 cm × 3.5 cm. Flap advancement distance was 1.5-2.5 cm. Donor area was sutured directly. Wound healing and color, swelling and temperature of the flap were observed after operation. Finger function was assessed with the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association. Results Postoperatively, the flap survived and the fingertip had protective sensation. The wound healed by first intention. Two patients developed distal interphalangeal joint stiffness, and restored to normal after rehabilitation. All patients were followed up for 1-36 months （mean, 20 months）. Finger color, temperature, texture and pulp were restored. Finger function recovered satisfactorily, with excellent results in 22 patients and good results in 2 patients. Conclusion The procedure is easy and reliable, has atErmative effect and achieves maximal preservation of finger length and function.