跗外侧皮瓣与邻指皮瓣修复手指皮肤缺损的比较

Innervated lateral tarsal flap versus adjacent digital flap for repairing the finger skin and soft tissue defect

[目的]比较吻合神经的跗外侧皮瓣与邻指皮瓣修复手指皮肤软组织缺损的临床效果。[方法]回顾2010年10月~2013年10月本院收治的54例手指皮肤软组织缺损行修复手术的患者,其中行吻合神经的跗外侧皮瓣26例,邻指皮瓣28例,对比两组皮瓣的外形评分、感觉评级、TAM评分并进行统计学分析。[结果]术后随访10~18个月,失访4例。感觉评级,跗外侧皮瓣组:20例S3+,4例S3;邻指皮瓣组:皮瓣指4例S3+,22例S3(P<0.05)。外形评分,跗外侧皮瓣组:8.1~10分21例,6.1~8分3例;邻指皮瓣组:皮瓣指8.1~10分23例,6.1~8分3例(P>0.05)。TAM评分,跗外侧皮瓣组:优22例,良2例;邻指皮瓣组:皮瓣指优24例,良2例(P>0.05)。[结论]吻合神经的跗外侧皮瓣较邻指皮瓣具有较优的感觉优势。

[Objective] To compare the clinical outcomes of the lateral tarsal flap with nerve anastomosis versus the adja- cent digital flap for repairing the finger skin and soft tissue defect. [Methods] Fifty-four patients with finger skin and soft tis- sue detect received flap repairing from October 2010 to October 2013, including 26 patients by lateral tarsal flap with nerve anastomosis and 28 patients with adjacent digital flap. The clinical outcome were observed and compared between two groups on tile sensation grade, appearance score, and the total active movement （TAM） score. [Results] Except 4 patients who were lost to follow-up, the remaining patients were followed up for 10 to 18 months with an average of 15 months. Sensation of the injured finger was graded as S3＋ in 20 patients and S3 in 4 patients in the lateral tarsal flap group, while S3＋ in 4 patients and $3 in 22 patients in the adjacent digital flap group, with a significant difference between the two groups （P〈0.05） . Addi- tionally, appearance score were 8.1 tol0 in 21 patients and 6.1 to 8 in 3 patients in the lateral tarsal flap group, whereas 8.1 to 10 points in 23 patients and 6.1 to 8 points in 3 patients in the adjacent digital flap group, without a significant difference be- tween them （P〉0.05） . Furthermore, TAM score was marked as excellent in 22 patients, good in 2 patients in the lateral tar- sal flap group, by contrast, excellent in 24 patients and good in 2 patients in the adjacent digital flap group, without a signifi- cant difference either （P〉0.05） . [Conclusion] The lateral tarsal flap with nerve anastomosis has an advantage of improved sensation recovery over the adjacent digital flap.