拇指背侧皮神经营养血管皮瓣修复拇指远端软组织缺损的临床应用

Clinical application of dorsal thumb neurocutaneous vascular flap for repairing distal soft tissue defects in thumb

目的探讨拇指背侧皮神经营养血管皮瓣修复拇指远端软组织缺损的临床疗效。方法回顾性分析自2013-06—2014-12采用拇指背侧皮神经营养血管皮瓣修复的15例拇指远端软组织缺损。皮瓣切取面位于拇指掌骨桡侧或尺侧背面,切取皮瓣的蒂部保持1 cm左右宽度,确保拇指指背动脉在蒂内,松开止血带,结扎浅静脉,确认皮瓣的血运良好,将皮瓣旋转180°覆盖于拇指远端创面,同时找到指神经残端,将皮神经与其吻合,缝合创面。结果术后15例均获得随访1.5~12个月,平均8个月。疗效根据赵书强等改进的手功能评定标准评定：优11例（73.3%）,术后伤口一期愈合,愈合时间7~14 d;良3例（20.0%）,术后伤口二期愈合,皮瓣远端皮肤少许边缘性坏死,愈合时间14~21 d,指间关节活动度接近正常范围,受限5°~10°;差1例（6.7%）,术后皮瓣供血差,肿胀明显,第5天皮瓣坏死,采用腹股沟游离皮瓣修复。结论采用拇指背侧皮神经营养血管皮瓣修复拇指远端软组织缺损手术操作简单,不破坏主要血管神经,对供区影响小,修复的拇指外形、指腹感觉恢复满意。

Objective To investigate the clinical results of repairing the distal soft tissue defects in the thumb with the dorsal thumb neurocutaneous vascular flap. Methods Retrospective analysis of repairing 15 cases of the distal soft tissue defects in the thumb with the dorsal thumb neurocutaneous vascular flap from June 2013 to December 2014 was conducted. The flap pedicle was about 1 cm wide with the thumb dorsal artery in the pedicle, the tourniquet was released, superficial vein was ligated, it was confirmed that the flap with good blood circulation, the flap was rotated 180 degrees to cover the distal soft tissue defects in the thumb, at the same time the thumb nerve stump was found, the cutaneous nerve was anastomosed with nerve stump and wound was sutured. Results After the operation, 15 cases were followed up for 1.5-12 months, average 8 months. The effect were evaluated according to the improved hand function standard of Zhao Shuqiang, excellent in 11 cases （73.3%）, the wounds healed by first intention, healing time was 7 to 14 days; good in 3 cases （20.0%）, the wounds healed by secondary intention, the distal end marginal skin of the flap had little necrosis, healing time was 14 to 21 days, the thumb interphalangeal joint movable degree was close to normal, with limit of 5 to 10 degrees~ poor in 1 case （6.7%）, after the operation, the flap had poor blood supply, highly swollen, and necrosis occurred on the fifth day, and was repaired with the groin flap. Conclusion The operative method of repairing the distal soft tissue defects in the thumb with the dorsal thumb neurocutaneous vascular flap is simple, without destroying the main blood vessels and nerves, with little influence on the donor site, the appearance of the repaired thumb and sensory of the thumb pulp recovery are satisfactory.