拇指背皮神经营养血管皮瓣修复拇指远端软组织缺损

Repair of soft tissue defect in distal thumb with dorsal thumb neurocutaneous vascular flap

目的总结采用拇指背皮神经营养血管皮瓣修复拇指远端软组织缺损的手术方法和临床疗效。方法2014年1月至2016年12月。对32例拇指远端软组织缺损的患者采用拇指背皮神经营养血管皮瓣移植修复。修复甲床缺损7例、甲下指腹缺损9例、指端或残端缺损16例；皮肤软组织缺损范围为1．5cm×1．0cm～3．5cm×3．2cm；皮瓣切取面积为2．0cm×1．5cm．4．0cm×3．5cm。均采用患者来门诊复查的方式进行随访。结果术后1例皮瓣因缝合过紧出现血液循环障碍．给予间断拆除部分缝线后解除：1例术后3个月出现皮瓣萎缩．末节指骨外露，给予咬除末端部分指骨后关闭创面；其余皮瓣均顺利成活，切口及供区植皮均Ⅰ期愈合。32例中随访0．5年以上的患者中，甲床缺损4例（总7例）、甲下指腹缺损5例（总9例）、指端或残端缺损9例（总16例）：随访0．5年以上的患者18例，皮瓣外形、质地均良好．恢复保护性感觉，皮瓣两点分辨觉为8～10mm：基本恢复了拇指原有的外形及功能。依中华手外科学会上肢部分功能评定试用标准：优11例，良17例，中4例，优良率87．5％；供区无影响。结论采用拇指背皮神经营养血管皮瓣修复拇指远端皮肤软组织缺损，其操作简单、手术风险小、成功率高、疗效满意；既适合于技术条件及设备好的医院开展，也适合于在基层医院推广应用。

Objective To evaluate the surgical methods and clinical effects of the reconstruction of soft tissue defect in distal thumbwith dorsal thumb neurocutaneous vascular flap. Methods From January, 2014 to December, 2016, 32 patients with soft tissue defects of distal thumb were repaired with dorsal thumb neurocutaneous vascular flaps, including left thumbs in 11 cases and right thumbs in 21 cases. They were including 7 cases of nail bed defects, 9 cases of pulp defects under nails, 16 cases ofthe defects of tips or stump of fingers; skin and soft tissue defects range of 1.5 cm×1.0 cm-3.5 cm×3.2 cm; Flap cutting areas range of 2.0 cm×1.5 cm-4.0 cm×3.5 cm. If the donor areas could be sutured directly, be sutured; if they could not, be covered with intermediate split thickness skin grafts. All patients were followed up when they were reviewed in outpatient department, and to be evaluated the shape, texture, sensation, flexion and extension function, and donor site of the flaps. Results One case of flaps blood circulation disordereddue to tight suture, and eased after the removal of part of the sutures; One case of flaps atrophied, and the phalangette was exposed after 3 months, so we removed the end part of bone and the wound was closed; other flaps were survived, with primary wound healing. In the total 32 patients, they were followed up range of 3 to 36 months,with an average of 12 months. Eighteen cases were followed up at least 6 months, which were 4 of the 7 cases of nail bed defects, 5 of the 9 cases of pulp defects under nail and 9 of the 16 cases of the defects of tip or stump of fingers. The appearances and textures of flaps were good, protective sensations were restored, and skin flap two-point discrimina- tionswere 8-10 mm. According to the Trial Standard for Evaluation of Upper Limb Function of Chinese Society of Hand Surgery, it was excellent in 11 cases, good in 17 cases and moderate in 4 cases, with the excellent and good rate of 87.5%. Conclusion It has advantages of simple operation, low risk, high success rate and satisfactory curative effects of the use of dorsal thumb neurocutaneous vascular flap for repair of distal thumb defect of skin and soft tissue. It is not only suitable for the hospital with good technical and equipment, but also suitable for the primary hospital.