带部分甲床的单侧或双侧V-Y推进皮瓣修复手指末节皮肤及甲床缺损

Application of unilateral or bilateral V-Y advanced flap combined with partial nail bed for repairing the defect of skin and nail bed at the end of finger

目的总结带部分甲床的单侧或双侧"V-Y"推进皮瓣修复手指末节皮肤及甲床缺损的治疗效果。方法对2014年2月-2016年12月收治的10例12指末节指腹、指端皮肤软组织及残留甲基质的甲床缺损患者,带远端部分甲床的单侧或双侧"V-Y"推进皮瓣修复创面。结果所有患者均获得随访,随访时间6~21个月,平均15个月。术后皮瓣及甲床全部成活,无一例发生感染,创面Ⅰ期愈合;手指指端饱满圆滑、外形良好,无疼痛及瘢痕挛缩;皮瓣质地柔软,指甲光滑平整。术后9个月根据中华医学会手外科学会上肢部分功能评定试用标准评定手功能:优10指,良2指,优良率100%。结论带部分甲床的单侧或双侧"V-Y"推进皮瓣修复手指末节皮肤及残留甲基质的甲床缺损,手术操作简单,皮瓣血供可靠,可保留指体长度,减少二次损伤,术后疗效满意,是修复手指末节皮肤软组织及部分甲床缺损较为理想的手术方法之一。

Objective To summarize the clinical effect of unilateral or bilateral V-Y advanced flap combined with partial nail bed at the end of finger. Methods From February 2014 to December 2016, 10 cases of fingertip and finger pulp defect and nail bed defect with residual onychostroma in 12 fingers were enrolled. The Defect was repaired by the unilateral or bilateral V-Y advanced flap combined with partial nail bed. Results All the flaps and nail beds survived without any infection, the wound healed at the first stage. All cases were followed up for 6-21 months, with an average of 15 months. The fingertip was full and smooth, the appearance was good without pain or scar contracture, the texture of flap was soft, the nail was smooth and levehng. According to the Criteria of the Chinese Medical Association of Hand Surgery Society upper part function assessment, excellent in 10 fingers, good in 2 fingers. The excellent and good rate was 100%. Conclusion The apphcation of unilateral or bilateral V-Y advanced flap combined with partial nail bed for repairing skin defect at the distal session and nail bed defect with residual onychostroma, it has the advantage of simple operative procedure, reliable blood supply, and preserve the digital length, reduce secondary injury, and has satisfactory postoperative effect. It is one of the ideal methods for repairing the soft tissue and partial nail bed defect at the end of finger.