指蹼动脉穿支与指动脉背侧支血管网皮瓣修复指腹缺损

Clinical application of web-space artery perforator and dorsal branch of the proper digital artery network flap for repair of finger pulp defects

目的评价指蹼动脉穿支与指动脉背侧支血管网为轴型血管的岛状皮瓣修复指腹缺损的治疗效果。方法自2015年1月至2017年5月，我们采用指蹼动脉穿支与指动脉背侧支血管网皮瓣修复指腹缺损患者30例（36指），并将指神经残端与指背神经缝合重建皮瓣感觉。指腹缺损面积为1．1cm×0．8cm～2.3cm×4．0cm。供区直接缝合或游离植皮修复。结果术后3例皮瓣远端出现张力性水泡，表皮结痂，经换药皮瓣边缘放血后Ⅱ期愈合；1例部分皮瓣坏死结痂，脱痂后痊愈；其余皮瓣均顺利存活，创面Ⅰ期愈合。术后所有患者均获得随访，时间为3～24个月，平均16．8个月。皮瓣质地柔软，外观满意。术后2个月皮瓣恢复痛温觉，术后3个月恢复触觉。术后6个月恢复两点分辨觉，平均为7．5mm；术后12个月平均为6．2mm。手指功能按主动活动度（total active movement，TAM）评分法评定达105°～230°，平均204．6°：优22指，良11指，可2指，差1指，优良率为91．7％。结论与传统的指动脉岛状皮瓣相比，指蹼动脉穿支与指动脉背侧支血管网为轴型血管的岛状皮瓣修复指腹缺损，延长了血管蒂长度，扩大了手术适应证。并且手术操作简便、安全，是一种修复指腹缺损的较好方法。

Objective To evaluate the clinical efficacy of web-space artery perforator and dorsal branch of the proper digital artery network flap in the treatment of finger pulp defects. Methods From January 2015 to May 2017, 30 cases （36 fingers） of finger pulp defects were treated by web-space artery perforator and dorsal branch of the proper digital artery network flap. The nerve stump and dorsal digital nerve were sutured to reconstruct the flap sensation. The area of finger pulp defects ranged from 1.1 cm ×0.8 cm to 2.3 cm×4.0 cm. The donor site was sutured directly or covered with skin graft. Results After the operation, tension vesicles appeared at the distal end of the flap in 3 cases which achieved secondary healing after dressing changes and flaps edge bleeding. Partial skin flap necrosis and scab occurred in 1 case that achieved healing after the decrustation. The rest of the flaps achieved primary healing. All the patients were follow- up for 3 to 24 months with an average of 16.8 months. The texture of skin flap was soft with satisfactory appearance. The skin flap recovered pain and temperature sensation 2 months after operation. And 3 months after the operation, the tactile sensation was restored. The two-point discrimination was recovered at 6 months after operation, with an average of 7.5 mm and an average of 6.2 mm at 12 months postoperatively. The total active movement （TAM） achieved 105° to 230° with an average of 204.6°. The results were graded as excellent in 22 fingers, good in 11 fingers, fair in 2 fingers, and poor in 1 finger with an excellent and good rate of 91.7%. Conclusion Compared with the traditional digital artery island flap, the island flap of web-space artery perforator and dorsal branch of the proper digital artery is used to repair the defects of the finger pulp, lengthening the length of the pedicle and enlarging the indication of the operation. The operation is simple and safe. It is a better method to repair the defect of the finger pulp.