近节指背筋膜皮瓣修复同指中节皮肤缺损

Repair of skin defects of the intermediate phalanges with dorsal fascia flap of the proximal phalanx

目的探讨近节指背筋膜皮瓣修复同指中节皮肤缺损的方法及疗效。方法采用近节指背筋膜皮瓣逆向转移修复13例同指中节皮肤缺损患者,切取皮瓣面积为1.2 cm×1.8 cm～2.5 cm×4.2 cm。结果 13例皮瓣修复均愈合良好;其中1例皮瓣出现远侧缘少许坏死,2例皮瓣术后出现色泽暗紫及张力性水疱,予拆除蒂部缝线、解除敷料压迫、抬高患肢等处理措施,均于3～4周脱痂后愈合。供区植皮均一期愈合。患者均获得随访,时间为4～13个月。皮瓣色泽与正常指相近,外观饱满,质地柔软,无臃肿、磨损破溃现象,两点分辨觉8～15 mm。患指修复术后瘢痕无挛缩,皮瓣供区无疼痛,手指活动功能基本恢复。结论应用近节指背筋膜皮瓣修复同指中节皮肤缺损具有良好的临床疗效,患指外观满意,活动功能恢复良好。

Objective To investigate the method and curative effect of digital dorsal fascia flaps of proximal phalanges on repairing defect of skin of the intermediate phalanges. Methods The digital dorsal fascia flaps of proximal phalanges were used to repair skin defects of the intermediate phalanges in 13 patients,of whom the cut flaps area ranged from 1. 2 cm × 1. 8 cm to 2. 5 cm × 4. 2 cm. Results The 13 patients with skin defects recovered from the flap repair surgeries. One of 13 patients had necrosis around the far lateral edge. The repaired skin of another 2 patients had tension vesicles appearing dark purple. Measures,such as removing the stitches,relieving the compression of dressings and raising the injured hands,were taken to solve the aforementioned problems. After that,the flap closed up after decrustation within 3 ～ 4 weeks,and the donor skin grafts were in primary healing. The patients were followed up within 4 ～ 13 months. The colors of the flaps were similar to normal fingers; the flaps were full with soft texture,and without fat and wear and rupture; the two-point discrimination was 8 ～ 15 mm. After the flap repair surgeries,the scar of the injured fingers had no contractures,the donor area of the flaps had no pains,and the function of the finger movement were basically recovered. Conclusions The application of digital dorsal fascia flaps of proximal phalanges in the repair of skin defect of the intermediate phalanges has a good clinical efficacy,which shows its good clinical application value. The appearance of the injured fingers is satisfactory.