第1掌背动脉穿支蒂皮瓣Ⅱ期修复拇示指远端皮肤软组织缺损

Repair soft tissue defects of thumb and index finger with the first dorsal metacarpal artery perforator flap in the second phase

目的探讨第1掌背穿支蒂皮瓣Ⅱ期修复拇、示指远端软组织缺损的临床疗效。方法采用回顾性病例系列研究分析2015年11月-2018年12月上海交通大学医院附属新华医院(崇明)收治的11例(12指)拇、示指软组织缺损患者临床资料,其中男4例,女7例;年龄35~56岁,平均45岁。采用第1掌背穿支蒂皮瓣Ⅱ期修复拇指9指,示指(1例双示指)3指,共12指。根据皮瓣成活、弹性色泽、外观形态、感染控制、供区瘢痕、皮肤感觉、手指功能、患者认可等情况对疗效进行评价。结果12指皮瓣全部成活,供、受区伤口Ⅰ期愈合,1例皮瓣远端发生皮缘坏死,给予换药处理,供、受区伤口均完全愈合。术后随访6~36个月,平均12个月。皮瓣成活优良,形态满意,色泽、弹性与周围正常皮肤接近,供区瘢痕较小。疗效评价:满意10指,一般2指,无不满意。手指功能评价:优8指,良3指,可1指。皮瓣肿胀评价:早期Ⅰ度8指,Ⅱ度3指,Ⅲ度1指;后期I度10指,Ⅱ度2指,Ⅲ度0指。结论第1掌背穿支蒂皮瓣Ⅱ期修复拇、示指软组织缺损,方法简便、安全可靠、损伤较小,且Ⅱ期修复较Ⅰ期修复具有创面稳定、感染控制、术前准备更充分等优点,有利于创面愈合及手指功能恢复。

Objective To evaluate the clinical effect of the second phase repair of thumb and index finger defects with the first dorsal metacarpal artery perforator flap.Methods The clinical data of 11 patients with defects of thumb or index finger from November 2015 to December 2018 were analyzed retrospectively,which included 4 men and 7 women whose ages ranged from 35 to 56 years old and the mean age was 45 years old.12 fingers were repaired with the first dorsal metacarpal artery perforator flap in which thumb were 9 and index finger were 3.Evaluated the effect according to survival,infection control,elasticity and color,appearance,the scar at the donor site,cutaneous sense,finger function and satisfaction of patients.Results All the flaps survived in 12 fingers,the incisions in donor and recipient site were primary healing.The survival of flaps was good and the appearance,color and elasticity was close to normal,on the other hand,the scar at the donor site was small after 6 to 36 months follow-up.The efficacy is satisfactory in 10 fingers,general in 2 fingers and without dissatisfactory.The function of finger was excellent in 8 fingers,good in 3 fingers and fair in 1 finger.Skin swelling rating in early stage was 1 st degree in 8 fingers,2 nd degree in 3 fingers,3 rd degree in 1 finger,in later stage,1 st degree in 10 fingers,2 nd degree in 2 fingers.Conclusion It is simple,safe and reliable to repair soft tissue defects of thumb and index finger with the first dorsal metacarpal artery perforator flap and compared with the first phase operation it has the advantages of more stable wound surface,more effective infection control and more adequate preoperative preparation which would be more conductive to wound healing and finger function recovery.