附加桡侧指动脉为血管蒂示指背侧皮瓣修复拇指皮肤缺损的疗效

Efficacy of reconstruction of thumb skin defect with dorsal index finger flap pedicled with radial digital proper artery

目的探讨附加桡侧指动脉为血管蒂的示指背侧皮瓣修复拇指皮肤缺损的疗效。方法采用回顾性病例对照研究分析2009年8月-2015年9月收治的78例拇指皮肤缺损患者临床资料，按照治疗方法分为A组和B组。A组47例，采用附加桡侧指动脉为血管蒂的示指背侧皮瓣修复拇指皮肤缺损，其中男31例，女16例；年龄20～54岁，平均29．6岁。皮肤缺损面积（9．02±0．45）cm2。B组31例，采用传统示指背侧皮瓣修复拇指皮肤缺损，其中男22例，女9例；年龄19～55岁，平均27．3岁。皮肤缺损面积（7．15±0．72）cm2。比较两组患者皮瓣切取面积、手术时间、术后视觉模拟评分（VAS）、皮瓣成活率、术后两点辨别觉恢复，以及中华医学会上肢部分功能评定标准评分（关节活动度、外形、肌力、感觉恢复、后遗症与工作能力）等。结果A组皮瓣切取面积为（9．25±0．78）cm2，B组为（7．25±0．61）cm2（P〈0．05）。A组手术时间为（1．75±0．36）h，B组为（1．64±0．29）h（P〉0．05）。A组VAS为（7．40±0．36）分，B组为（6．33±0．47）分（P〉0．05）。A组皮瓣全部成活，无表皮坏死、水疱形成等，成活率为100％；B组术后部分或全部坏死4例，成活率为87％（P〈0．05）。A组两点辨别觉为（6．33±1．41）mm，B组为（8．80±1．43）mm（P〈0．05）。按中华医学会上肢部分功能评定标准：A组优21例，良22例，差4例，优良率为92％；B组优14例，良8例，差5例，劣4例，优良率为71％（P〈0．05）。结论利用附加桡侧指动脉为血管蒂的示指背侧皮瓣修复拇指皮肤缺损，增加了皮瓣的切取面积，能提高皮瓣成活率及成活质量，促进上肢功能恢复，值得临床推广。

Objective To investigate the effect of dorsal index finger flap pedicled with radial digital proper artery for reconstruction of thumb skin defect. Methods A retrospective case series study was conducted on the clinical data of 78 patients with thumb skin defect admitted from August 2009 through September 2015. According to the treatment method, the patients were divided into Group A which adopted dorsal index finger flap pedicled with radial digital proper artery and Group B which adopted the conventional dorsal index finger flap for the reconstruction of thumb skin defect. Group A （n = 47 ） comprised of 31 males and 16 females, aged averagely 29.6 years （range, 20-54 years）, and Group B （ n = 31 ） comprised of 22 males and nine females, aged averagely 27.3 years （ range, 19-55 years）. The dimensions of skin defect were （9.02 ± 0.45 ）cm2 in Group A and （7.15 ± 0.72）cm2 in Group B. The cut flap area, operation time, postoperative visual analogue score （VAS） , flap survival rate, two point discrimination recovery, and evaluation criteria of the upper limb function of the Chinese Medical Association （ joint activity, shape, muscle strength, sensory recovery, sequelae, and work ability） were compared between Groups A and B. Results The cut flap area was （9.25 ± 0.78） cm2 in Group A and （7.25 ± 0.61 ） cm2 in Group B （ P 〈 0.05 ）. The operation time was （ 1.75 ± 0.36 ） hours in Group A, and （ 1.64± 0.29） hours in Group B （P 〉 0.05 ）. The VAS was （7.40 ± 0.36） points in GroupA, and （6.33 ±0.47）in Group B （P 〉0.05）. All flaps of Group A survived without any epidermal necrosis or bister, with the survival rate of 100% ; while four cases of Group B had partial or total necrosis, with the survival rate of 87% （P 〈 0. 05）. The two point discrimination was （6.33 ±1.41 ） mm in Group A, and （8.80 ± 1.43 ） mm in Group B （P 〈 0.05 ）. According to the evaluation criteria of the upper limb function of the Chinese Medieal Association, the results of Group A were excellent in 21 cases, good in 22, and poor in four, with the excellent and good rate of 92% ; while the results of Group B were exeellent in 14 eases, good in 8, poor in 5, and worst in 4, with the excellent and good rate of 71% （P 〈 0.05 ）. Conclusion Dorsal index finger flap pedieled with radial digital proper artery for the reconstruction of thumb skin defect is worthy of clinical practices, for the advantages of larger cut flap area, improved flap survival rate and quality, and better recovery of upper limb funetion.