应用两种皮瓣修复拇指指腹缺损的疗效对比

Efficacy comparison of two types of flaps in the repair of thumb pulp defects

目的比较采用两种皮瓣修复拇指指腹缺损的临床疗效。方法收集2012年1月至2018年10月收治的拇指指腹缺损患者60例,根据治疗方法分为A组(30例)和B组(30例)。A组采用拇指桡背侧皮神经营养血管皮瓣修复;B组采用示指背侧皮瓣修复。术后6个月评价皮瓣的感觉恢复情况、检测皮瓣功能、皮瓣两点辨别觉,比较两组手术时间、术中出血量等方面的差异。结果两组术后皮瓣的感觉恢复及手部皮瓣晚期功能比较,其差异无统计学意义(P>0.05)。皮瓣两点辨别觉比较,B组(6.54±0.68)mm明显小于A组(7.51±0.71)mm;手术时间比较,B组明显长于A组;术中出血量比较,B组明显多于A组;以上差异均有统计学意义(P<0.05)。结论采用拇指桡背侧皮神经营养血管皮瓣修复拇指指腹缺损,手术时间短、出血量较少、操作简单;示指背侧皮瓣修复在两点辨别觉恢复方面有明显优势。两种手术方法各有优缺点,应根据患者的具体情况及要求合理选择手术方式。

Objective To compare the clinical efficacy of two types of flaps in the repair of thumb pulp defects.Methods A total of 60 patients with thumb pulp defects from January 2012 to October 2018 were collected.According to different treatment methods,all patients were divided into group A(30 cases)and group B(30 cases).The radial dorsal thumb neurocutaneous nutrient vascular flap was used in group A and the dorsal index finger flap was used in group B.The patients were followed up for 6 months after operation,and the sensory recovery,function and twopoint discrimination of the flap were evaluated.The operation time and intraoperative blood loss between two groups were compared.Results There was no significant difference in sensory recovery and late function of hand flap between two groups(P>0.05).The two point discrimination of flap in group B[(6.54±0.68)mm]was significantly lower than that in group A[(7.51±0.71)mm],the operation time in group B was significantly longer than that in group A,and the intraoperative blood loss in group B was significantly higher than that in group A.The above differences were statistically significant(P<0.05).Conclusion The application of radial dorsal thumb neurocutaneous nutrient vascular flap in the repair of thumb pulp defects has the advantages of short operation time,less blood loss and simple operation.Two surgical methods have advantages and disadvantages.The surgical method should be reasonably selected according to the patient’s specific conditions and requirements.