拇指掌指关节背侧横向切取指掌侧固有动脉穿支皮瓣修复指端缺损

Homodigital metacarpophalangeal dorsal transverse flap based on the dorsal branch of the proper palmar digital artery for resurfacing fingertip defects of the thumb

目的 探讨应用拇指掌指关节背侧横向切取指掌侧固有动脉穿支蒂皮瓣修复指端缺损的方法及临床效果。方法从2013年11月至2015年5月，拇指指端缺损的患者17例，其中男11例，女6例，年龄18～46岁，平均31.3岁。在拇指掌指关节背侧横向设计切取以指掌侧固有动脉背侧穿支为蒂的皮瓣修复指端缺损，皮瓣供区直接缝合，其中13例将皮瓣内的指背侧神经与受区指固有神经吻合重建皮瓣感觉。拇指软组织缺损面积1．5cm×2．0cm～2．0cm×2．5cm，皮瓣切取面积1．8cm×2．0cm～2．0cm×2．8cm。结果术后皮瓣全部成活，术后均获随访，时间5～15个月，皮瓣质地柔软，不臃肿，无明显色素沉着，感觉恢复两点辨别觉6-10mm，吻合神经的皮瓣感觉恢复优于未吻合神经的皮瓣。结论该皮瓣手术操作简单，皮瓣外形好．血供可靠，掌指关节背侧横向切取皮瓣后供区可直接缝合，无需植皮，皮瓣均能恢复部分感觉。拇指掌指关节背侧横向切取穿支蒂皮瓣是修复拇指远端软组织缺损较为理想的方法。

Objective To investigate the surgical methods and clinical results of repairing skin defect of the thumb with the homodigital metacarpophalangeal dorsal transverse flap based on the dorsal branch of the proper palmar digital artery. Methods From November, 2013 to May, 2015, 17 cases skin defects of the thumb were treated with the homodigital metacarpophalangeal dorsal transverse flap based on the dorsal branch of the digital artery close to the defect. Of the 17 patients, 11 were males and 6 were females. Their ages ranged from 18 to 46 years, with average of 31.3 years. The digital nerve of 13 patients was attached with the flap to restore neurosensory function. The size of fingertip losses ranged from 1.5 cm × 2.0 cm to 2.0 cm× 2.5 cm. The size of the flaps ranged from 1.8 cm× 2.0 cm to 2.0 cmx 2.8 era. Results The homodigital metacarpophalangeal dorsal transverse flap based on the dorsal branch of the digital artery survived uneventfully during the follow-up period between 5 to 15 months. All the patients were contented with the aesthetic and functional outcomes of the flaps. The 2-point discrimination of the flaps was 6 mm to 10 mm. Conclusion The homodigital metacarpophalangeal dorsal transverse flap based on the dorsal branch of the digital artery is reliable alternative to reconstruct fingertip defects of the thumb at the primary stage.The main advantages of the flap include the simplicity of its procedure; the reliable blood supply and return of sensation.