带皮瓣的指动脉移位在拇指旋转撕脱离断再植中的应用

The application of digital artery transposition with a flap in replantation of rotational avulsed thumb

目的探讨拇指旋转撕脱离断再植中应用带皮瓣的指动脉移位重建血运并覆盖创面的临床疗效。方法自2010年2月至2014年12月，对11例11指拇指撕脱离断伤合并皮肤缺损患者实施血管神经移位、肌腱转位的断指再植术，一期采用同手中指尺侧或环指桡侧指动脉携带皮瓣移位，重建拇指血运并覆盖创面。修复拇指桡侧皮肤缺损8例，尺侧皮肤缺损3例，缺损面积1．5（：m×1．0cm～4．5cm×4．0cm。切取环指桡侧指动脉皮瓣8例，中指尺侧指动脉皮瓣3例。结果11指中9指顺利存活，2指发生血管危象探查后存活；11块皮瓣存活。供区植皮成活良好。术后随访6～24个月，再植拇指外形良好，血运良好，指腹饱满，末节指腹两点分辨觉7～11mm；皮瓣外形质地良好，感觉神经功能评级S3＋。结论带皮瓣的指动脉移位用于伴有皮肤缺损拇指撕脱离断再植，血供呵靠，同时修复创面，监测血运，不短缩拇指，效果满意。

Objective To investigate the clinical results oftransposing the digital artery with a flap in replantation of rotational avulsed thumb for restoring perfusion and covering the wound. Methods From February 2010 to December 2014, 11 thumbs with rotational avulsion injury combined with skin defect were replantated with neurovaseular transpnsition and tendon transfer. Simultaneously an island flap based on ulnar digital artery of the middle finger or radial digital artery of the ring finger was transferred to eover the wound, while the flap artery was inset in the digital artery of the replanted thurnb to establish peffusion to the replant. The island flap covered defect on the radial aspeet of the thumb in 8 eases and on the ulnar aspect in 3 eases. The size of the defects ranged from was 1.5 cm × 1.0 cm to 4.5 cm ×4.0 cm. Radial digital artery flap of the ring finger was harvested in 8 eases while ulnar digital artery flap of the middle finger was harvested in 3 cases. Results Nine of the 11 thumbs sm＇vived uneventfully. Vaseular crisis oceurred in 2 eases which were rescued by exploration of the vessels. All 11 flaps survived, and so did skin grafts at the donor sites. Postoperative foUow-up period ranged from for 6 to 24 months. The replanted thumbs not only looked good, but also had good peffusion and lull pulp. Two-point diseriminafion of the pulp was 7 to 11 mm . The texture and contour of the flaps were fine. Sensory recovery of the flaps was graded as S3 ＋ . Conclusion Inset digital ＇artery island flap transfer in replantation of rotational avulsed thumb with skin defect has such advantages as providing reliable blood supply, covering wound defects, monitoring perfnsion of deeper structures while not having to shorten the thumb.