拇指远端组织缺损的类型及显微外科治疗

Types of Distal Thumb Defect and Microsurgical Treatment

目的探讨分析拇指远端皮肤皮下组织缺损简单分型,根据简单类型选用不同显微外科手术治疗的方式。方法选取自2010年10月-2019年12月本科急诊收治的符合研究目的的拇指远端组织缺损患者63例,选择标准:(1)指间关节以远的复合组织缺损;(2)患者放弃移植再造,仅要求手术保留其长度;(3)患者残端创面污染较轻,适合一期手术;(4)患者无高血压等基础疾病,根据创面缺损将其简单分为3型:(1)偏尺侧缺损型;(2)偏桡侧缺损型;(3)中间缺损型,根据缺损分型采用不同显微外科手术方式治疗,观察术后患指在外形、肤色质地、功能、感觉等方面的恢复效果。结果61例全部成活,其余2例均为虎口背侧皮瓣,皮瓣边缘坏死,经创面规律换药疤痕愈合,患指总体外形满意、皮瓣色泽质地、感觉、功能良好。结论根据拇指远端组织缺损不同类型选择不同显微外科手术治疗方式,方法简单易行,疗效良好。

Objective To discuss and analyze the simple classification of subcutaneous tissue defects of distal thumb skin, and choose different microsurgical treatment methods according to the simple types. Methods From October 2010 to December 2019, 63 patients with distal thumb tissue defects were selected in our emergency department. The selection criteria were:(1) compound tissue defects distal to the interphalangeal joint;(2) Patients give up transplantation and reconstruction and only require surgery to preserve its length;(3) The wound surface of the stump of the patient is less polluted and suitable for one-stage operation.(4) Patients have no basic diseases such as hypertension, and can be divided into 3 types according to wound defects:(1) partial ulnar defect type;(2) Partial radial defect type;(3) The middle defect type was treated by different microsurgical methods according to the defect types. The recovery effects of the affected fingers in terms of shape, skin color, texture, function, sensation and other aspects were observed. Results 61 cases were all alive, 2 cases were necrosis of the dorsal island flap edge. After dressing change scar healing, the affected fingers were satisfied with the overall shape, color, texture, sensation and function of the flap. Conclusion Different microsurgical treatment methods are selected according to different types of distal thumb tissue defects. The method is simple and effective.