修薄的躅趾腓侧皮瓣移植修复手指指腹缺损

Recontraction by the microdissected thin fibular skin flap of the great toe for soft tissue defects of the finger

目的探讨显微修薄的趾腓侧皮瓣修复手指指腹缺损的手术方法和临床效果。方法2012年9月-2016年1月，应用显微镜下去除部分脂肪颗粒的修薄的趾腓侧皮瓣移植修复手指指腹缺损12例,其中挤压伤5例，冲压伤6例，撕脱伤1例；修复示指1例，中指3例，环指4例，小指4例。皮瓣面积：3.0 cm×1.5 cm^3.2 cm×2.2 cm，供区直接缝合或皮瓣修复。结果12例皮瓣成活，未出现血管危象，供区一期愈合。术后10例获得随访，随访时间6~36个月，皮瓣血运、质地、弹性良好、指腹饱满，外形满意。手指功能恢复良好，两点辨别觉5~8 mm。结论修薄的趾腓侧皮瓣修复手指，尤其是环、小指指腹缺损,可能是一个较好的方法。

ObjectiveTo investigate the therapeutic effect of the microdissected thin fibular skin flap of the great toe to repair the finger pulp defect, and to discuss the operation and outcome of the flap for finger pulp defect.MethodsFrom September, 2012 to January, 2016, 12 cases of finger pulp defect were treated with the thin fibular skin flap of great toe removed partially subcutaneous fat under the microscope. One case for index finger, 3 cases for middle finger, 4 cases for ring finger, and 4 cases for little finger. Among them, 5 cases were crush injury, 6 cases were stamping injury, 1 case was avulsion injury. The flap area was 3.0 cm×1.5 cm-3.2 cm×2.2 cm. The donor site was closed directly or covered with flap.ResultsAll the 12 flaps survived completely without blood supply crisis, and the primary healing was achieved in donor site. Ten cases were followed-up from 6 months to 36 months. The blood-supply, texture and elasticity of transferred flaps and the shape of fingers pulp were excellent. Function recovery of the fingers was good. Pain and temperature sense were regained without hypersensitivity, two-point discrimination of finger pulp was 5-8 mm.ConclusionIt is a reliable approrach for the repare of the finger pulp defects using the microdissected thin fibular skin flap of the great toe, especillay in repare finger pulp defect of ring and little finger.