带感觉神经尺动脉远端穿支微型皮瓣修复全指腹缺损

Application of the distal ulnar perforator minitype flap with anastomosed sensory nerve to repair the full pulp defect

目的介绍采用吻接感觉神经的尺动脉远端穿支微型皮瓣游离移植修复指腹软组织缺损的手术效果。方法 2006年4月至2012年2月,切取带感觉神经的尺动脉远端穿支微型皮瓣修复指腹软组织缺损32例34指,皮瓣切取面积1.5 cm×2.0 cm-3.0 cm×4.5 cm。结果术后1例皮瓣远端部分坏死,经换药后结痂愈合,其余31例33指皮瓣全部成活。除5例供区植皮存活外,其余供区创面均直接缝合,愈合良好,无明显瘢痕挛缩。随访时间12-36个月（平均16个月）,修复手指外形、功能均恢复满意。按中华医学会手外科学会手部功能评定标准评定：优26例,良5例,可1例;优良率为96.8%。皮瓣两点分辨觉为6-12 mm。结论前臂远端尺侧穿支血管解剖较恒定,供区隐蔽,修复后皮瓣质地色泽接近受区,指体外形恢复良好,皮瓣感觉恢复明显。吻接感觉神经的尺动脉远端穿支微型皮瓣是修复手指指腹缺损创面的较佳术式之一。

Objective To introduce the surgical effect of free transplantation of distal ulnar perforator minitype flap with sensory nerve to repair finger pulp soft tissue defect. Methods From April2006 to February 2012 in our hospital, 32 patients, including 34 fingers, with finger pulp soft tissue defect were repaired by free transplantation of forearm distal perforator flap with sensory nerve. The area of skin flaps differed from1.5 cm×2.0 cm to 3.0 cm×4.5 cm. Results 1 case had partial necrosis of distal flap after operation, and the scabs healed after dressing change. The remaining 31 cases all survived. Except for 5 cases of grafted skin for survival, the remaining donor sites were directly sutured, and healed well without obvious scar contracture. Follow-up ranged from 6 to 36 months with an average of 16 months, and the shape and function of the fingers were restored satisfactorily. The outcomes were graded as excellent in 26 cases, good in5 cases, and fair in 1 case according to the functional assessment criteria for upper extremities issued by the Hand Society of the Chinese Medical Association. Achieving a 96.8% good and excellent rate. Two-point discrimination of the flaps was 6 to 12 mm. Conclusion The forearm distal ulnar perforator has constant perforating point, which carry sensory nerves to repair finger pulp defects. The texture of the skin flap is close to the affected area, the shape of finger recoverd well, the flap sensation recovery is good. The distal ulnar perforator minitype flap with sensory nerve is one of the effective surgical procedures to repair the defect of finger pulp.