游离足拇指背侧皮瓣修复手指指腹皮肤缺损45例疗效观察

Clinical Observation on 45 cases of Finger Pulp Skin Defect Repairing with Free Foot Thumb Dorsal Skin Flap

【目的】探讨游离足拇指背侧皮瓣修复手指指腹皮肤缺损的疗效。【方法】选择2012年1月至2014年1月在本院外科接受手术的手指指腹缺损的患者90例，以数字法随机分为两组，每组45例。其中观察组采用游离足拇指背侧皮瓣进行修复，对照组采用髂腹皮瓣进行修复。比较两组手术情况、皮瓣成活率、肿胀情况及治疗前后焦虑、抑郁评分。【结果】观察组皮瓣成活率为95．56％（43／45），显著高于对照组82．22％（37／45）；观察组手术时间及出血量均显著少于对照组，而术后皮瓣肿胀及瘀血等的发生率明显少于对照组；观察组修复后感觉功能评分为S3的患者明显少于对照组，而评分为S4的患者多于对照组。两组治疗前SAS、SDS评分比较差异无统计学意义，在治疗后1周观察组SAS、SDS评分显著低于对照组，其差异均有统计学意义（P〈0．05）。【结论】采用游离足拇指背侧皮瓣修复手指指腹皮肤缺损中皮瓣成活率高，皮瓣肿胀及瘀血的发生率低，且术后愈合快，外形美观，对患者心理焦虑、抑郁的影响更小，值得临床推广应用。

[Objective]To explore the effect of free foot thumb dorsal skin flap in repairing the finger pulp skin defect. [Methods]Ninety patients with finger pulp defect in our hospital were selected from January 2014 to January 2012, and randomly divided into observation group and control group, each of 45 cases. The obser- vation group was repaired with the free foot thumb dorsal skin flap, and the control group was repaired with the iliac skin flap. The two groups were compared with the operation conditions, the survival rate of the skin flap, the swelling and the anxiety and depression score of the patients before and after treatment. [Results] The survival rate of the flaps in the observation group was 95.56% （43/45）, which was significantly higher than that of the control group＇s 82.22% （37/45）, and operation time and bleeding volume of the observation group were significantly less than those of the control group, and the incidence of flap swelling and congestion were also significantly lower than those of the control group. In the observation group, patients with S3 in sen- sory function scoring after repair were significantly less than those in the control group, and the score with S4 was more than that of the control group. Before treatment, the SAS and SDS scores of the two groups were compared, and the differences were not statistically significant. 1 week after treatment, SAS, SDS score of the observation group was significantly lower than that of the control group, the difference was statistically signifi- cant （ P 〈0.05）.[Conclusion] The adoption of free foot thumb dorsal skin in repair of finger skin pulp defect presents a higher survival rate of the skin flap ,lower rate of flap swelling and congestion, faster postoperative healing and more beautiful appearance ,while with less psychological anxiety and depression on patients . It is worthy of clinical popularization and application.