经重建感觉的指动脉终末背侧支逆行岛状皮瓣修复指端缺损的疗效观察

Clinical Observation of Reverse Island Flap of Dorsal Branch of Digital Artery in Reconstruction of Fingertip Defect

【目的】探讨重建感觉的指动脉终末背侧支逆行岛状皮瓣修复指端缺损的·临床效果。【方法】选取2015年1月至2016年12月在本院治疗的指端缺损70例患者78指，均行重建感觉的指动脉终末背侧支逆行岛状皮瓣修复，将神经分支和指固有神经残端吻合。【结果】本组70例中5例7指皮瓣于术后3d出现水疱，对症处理后愈合，其余皮辩均顺利成活，创面I期愈合；术后6个月恢复浅感觉比例为100．00％，明显高于术后3个月和1个月的76．92％和0．00％（P〈0．05）；术后1个月全部恢复深痛觉；术后6个月两点辨别觉为（5．48±1．14）mm，明显少于术后3个月（P〈0．05）；术后6个月皮瓣感觉恢复明显优于术后3个月和术后1个月（P〈0．05），s4级比例达到61．54％（48／78）。【结论】重建感觉的指动脉终末背侧支逆行岛状皮瓣修复指端缺损，是一种有效的方法，可使皮瓣感觉恢复，值得临床推广应用。

[Objective]To investigate the clinical effect of reconstruction sensory of reverse dorsal digital island flap of fingertip defects. [Methods]A total of 70 patients with 78 fingertip defects in our hospital from January 2015 to December 2016 were collected in the study. All patients underwent reconstruction sensory of reverse dorsal digital island flap and anastomosis of nerve branch and intrinsic nerve stump. [Results]In this study, skin blisters occurred in 5 cases of 7 fingers 3d after operation and healed after symptomatic treatment. The remaining flaps successfully survived and wounds healed very well. The rate of superficial sensory recovery at 6 months after operation was 100.00%, which was significantly higher than 76.92% and 0.00% at 3 months and 1 month after operation （ P 〈0.05）. All patients recovered from deep pain at one month after operation. At 6 months after operation, the two-point discrimination was （5.48±1.14） mm, which was significantly less than that of the postoperative 3 months （ P 〈0.05）. The sensory recovery of the flap at 6 months postoperatively was significantly better than that at 1 and 3 months postoperatively and the ratio of S4 reached 61.54% （48/78）.[Conclusion]Reconstruction sensory of reverse dorsal digital island flap of fingertip defects is an effective method to restore the skin flap.