缝合神经的邻指背顺行筋膜蒂皮瓣修复儿童手指皮肤缺损

Dorsal fascial pedicle flaps with dorsal nerve suture for repair of adjacent finger skin defects of children

目的探讨缝合神经的邻指背顺行筋膜蒂皮瓣修复儿童手指近中节皮肤缺损的临床疗效。方法自2007年4月至2016年5月，我们对13例儿童手指近中节皮肤缺损创面采用邻指背顺行筋膜蒂皮瓣转移修复，并将皮瓣内的神经与患指远端背侧神经缝合。其中急诊一期修复10例，二期修复3例。皮瓣切取面积为0．7cm×1．0cm～1．3cm×2．1cm，蒂长2．4～3．7cm。供区采用全厚皮片植皮覆盖。结果术后13例全部存活，其中1例起水泡，经抽吸换药后存活。术后随访时间为4-24个月，平均8个月，皮瓣质地、弹性均良好，患指功能恢复满意，远端背侧感觉恢复良好。结论采用缝合神经的邻指背顺行筋膜蒂皮瓣能有效修复儿童手指近中节皮肤缺损，是一种简单实用的修复方法。

Objective To explore the clinical effects of adjacent dorsal fascial pedicle flaps with dorsal nerve suture in repair of finger skin defects in proximal and middle segments of children. Methods From April 2007 to May 2016, 13 children with finger skin defects in proximal and middle segments were covered by adjacent dorsal fascial pedicle flaps. The nerve in the flap was sutured with the distal end of dorsal nerve of the affected finger. 10 cases were treated by emergency operation, and the other 3 cases were repaired in the second stage. The harvested flap area was 0.7 cm× 1.0 cm to 1.3 cm×2.1 cm. The pedicle length was 2.4 to 3.7 cm. The donor site was covered by full-thickness skin graft. Results All the 13 flaps survived. Blisters occurred in 1 case which survived after suction and dressing. Postoperative follow-up ranged from 4 to 24 months with an average of 8 months. The flaps had good texture and elasticity. The functional and sensory recovery of affected finger was satisfactory. Conclusion It is a simple and practical method for adjacent dorsal fascial pedicle flaps with dorsal nerve suture to repair finger skin defects in proximal and middle segments of children.