带感觉神经的足内侧静脉皮瓣在末节指腹缺损中的应用

Application of medial plantar venous flap with sensory nerves in the treatment of distal digital pulp defects

目的探讨带感觉神经的足内侧静脉皮瓣修复末节指腹缺损的临床应用及治疗效果。方法自2015年5月至2018年10月,我们采用带感觉神经的足内侧静脉皮瓣修复末节指腹皮肤软组织缺损患者14例21指。缺损面积为1.8 cm×0.6 cm^2.9 cm×2.1 cm,皮瓣设计至少含1条隐神经足内侧皮支或足底内侧神经皮支,供区采用全厚皮片植皮或直接缝合。结果术后21指皮瓣全部存活。供区植皮创面均Ⅰ期愈合。2例手指出现瘢痕屈曲挛缩畸形,远指间关节活动度大于60°。术后随访4~22个月,平均12个月,皮瓣外观良好,色泽、质地与周围皮肤相似,两点分辨觉为6.0~8.0 mm,平均6.8 mm。按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指主动活动度:优16指,良3指,可2指。皮瓣感觉功能按照英国医学研究委员会(BMRC)感觉评定标准(1954)评定:S415指,S35指,S21指。结论带感觉足内侧静脉皮瓣外观、质地接近手指,能修复受损的神经,重建末节指腹的感觉及功能,获得了较好的临床效果。

Objective To investigate the clinical application and efficacy of medial plantar venous flap with sensory nerves for repair of distal digital pulp defects.Methods From May 2015 to October 2018,14 cases(21 fingers)of distal digital pulp defects were treated by the medial plantar venous flap with sensory nerves.The defect area ranged from 1.8 cm×0.6 cm to 2.9 cm×2.1 cm.The flap was designed to contain at least one medial cutaneous branch of saphenous nerve or medial cutaneous branch of plantar nerve.The donor area was covered with full-thick skin graft or directly sutured.Results All the flaps survived.All the grafts in the donor area achieved primary healing.The scar flexion contracture deformity of fingers occurred in 2 cases,and the motion degree of distal interphalangeal joint was more than 60°.The postoperative follow-up time ranged from 4 to 22 months with an average of 12 months.The appearance of the flap was good,and the color and texture were similar to those of the surrounding skin.The flap two-point discrimination was 6.0 to 8.0 mm,with an average of 6.8 mm.According to the upper extremity functional evaluation criteria issued by the Hand Society of the Chinese Medical Association,the finger active motion was rated as excellent in 16 fingers,good in 3 fingers and fair in 2 fingers.According to the sensory evaluation standard issued by British Medical Research Council(1954),the sensory function of flap was S4 in 15 fingers,S3 in 5 fingers and S2 in 1 finger.Conclusion The medial plantar venous flap with sensory nerves is similar to the finger in appearance and texture.It can repair the damaged nerve,reconstruct the sensation and function of the digital pulp,and obtain better clinical efficacy.