多种游离微型穿支皮瓣修复手指皮肤缺损的疗效分析

Comparison of effect for repairing finger skin defects betweenfree mini-perforator flaps and traditional free flaps

目的比较3种新型游离微型穿支皮瓣和2种传统游离皮瓣修复手指皮肤缺损的疗效差异。方法将50例50指手指中小面积皮肤缺损的患者分成5组,采用5种游离皮瓣修复,包括3种新型游离微型穿支皮瓣:桡动脉掌浅支穿支皮瓣(SPBRAF组,10指)、骨间背动脉穿支皮瓣(PIPF组,10指)、尺动脉腕上支穿支皮瓣(UAPF组,10指),2种传统游离皮瓣:动脉化的静脉皮瓣(AVF组,11指)、游离趾腹皮瓣(FFPF组,9指)。通过随访,对比评价5组疗效差异。评价指标包括手术时间、客观感觉恢复、寒冷不耐受、返回原工作所需时间、伤指主动活动度(ROM)和供受区的美学评价。结果所有游离皮瓣均存活。平均随访13.5个月。SPBRAF组和AVF组平均手术时间明显短于其他手术组(P<0.05)。FTPF组、AVF组和SPBRAF组修复后的感觉恢复优于其他两组(P<0.05)。在ROM、寒冷不耐受和返回工作时间方面,5组间差异无统计学意义;感觉恢复方面,FTPF组优于其他组;其他4组中,AVF组和SPBRAF组优于PIPF组和uAPF组(P<0.05)。FTPF组、AVF组和SPBRAF组受区的美容满意度最高,而SPBRAF组的供区美容满意度最高。结论与经典的游离皮瓣比较,在修复手指中小面积皮肤缺损方面,游离微型穿支皮瓣,特别是桡动脉掌浅支穿支皮瓣,其手术操作简单,只涉及单一手术区域,感觉恢复佳,供区创伤小,值得重视和推广应用。

Objective To compare the surgical results of 3 types of new, free, mini-perforator flaps and 2 types of traditional free flapsin therepairof finger skin defects. Methods Fifty patients withfinger skin defects were divided into 5 groups. Five types of free flaps were used to repair the defects, including 3 types of new free mini-perforator flaps （10 SPBRAF, 10 PIPF, 10 UAPFs） and 2 types of traditional free flaps （9 FTPFs and 11 AVFs）. Through follow-up, the surgical among the 5 groups were compared according to the following factors： operationduration, objective sensory evaluation, cold intolerance, downtime, active range of motion （ROM） of the injured finger and cosmetic appearance of the donor/recipient sites. Results Follow-up was conducted for an average of 13.5 months and all flaps survived. The mean operative time of the AVFs and SPBRAFs groups was distinctly shorter than the other groups （P〈0.05）. The objective sensory results of the AVFs, SPBRAFs and FTPFs groups was better than in the other two groups （P〈0.05）. No significant difference was noted in ROM, cold intolerance or downtime among the 5 groups. Satisfaction with the cosmetic appearaneeof the recipient site was better in the AVFs, FTPFs and SPBRAFs groups, and satisfaction with the aesthetics of the donor site was better in the SPBRAFs group. Conclusion Compared with traditional free flaps, free mini-perforator flaps, especially the SPBRAFs, have the following advantages： the operation is simple, only involves a single operation area, there is good sensory recovery and less donor trauma. It should be considered for greater popularization and application in clinic.