示指背岛状皮瓣联合第2掌背动脉穿支皮瓣接力修复拇指缺损

Dorsal index finger flap combined with second dorsal metacarpal artery(SDMA)and its cutaneous branch flap for repairing soft tissue defect of thumb

目的探讨示指背岛状皮瓣联合第2掌背动脉穿支皮瓣接力修复拇指缺损的临床效果。方法2018年3月-2019年6月,应用示指背岛状皮瓣联合第2掌背动脉穿支皮瓣接力修复拇指软组织缺损9例,供区无需植皮。结果术后9例皮瓣均成活,1例术后第2天因皮瓣呈暗紫色张力高,给予拆线及小切口放血,换药后皮瓣成活。随访3~18个月,患者对功能及外观均较满意,皮瓣血运良好,不臃肿,质地柔软,皮肤颜色与受区相近,掌背侧仅留线形瘢痕,无瘢痕挛缩。根据中华医学会手外科学会上肢功能评定试用标准评定,优6例,良2例,可1例。结论采用示指背岛状皮瓣联合第2掌背动脉穿支皮瓣接力修复拇指缺损,一次完成手术,不增加手术切口及其他部位创伤。

Objective To investigate the clinical effect of dorsal index finger flap combined with second dorsal metacarpal artery(SDMA)and its cutaneous branch flap in repairing soft tissue defect of thumb.Methods From Mar 2018 to Jun 2019,9 patients’thumb skin and soft tissue defects were repaired by dorsal index finger flap combined with second dorsal metacarpal artery(SDMA)and its cutaneous branch flap.No skin-grafting was required.Results All 9 flaps survived after surgery.And darkpurple and increased tension appreared in one of flap and extincted after removing the suture,small incision bleeding,wound dressing changed.All patients were followed up from 3 to18 months,they were satisfied that the flaps were soft and had good appearance,guaranteed blood supply,no swollen,well restored finger function and had less influence on donor site.According to the upper extremity functional evaluation standard set up by hand surgery branch of Chinese Medical Association,the function was assessed as excellent in 6,good in2 and fair in 1.Conclusion Dorsal index finger flap combined with the second dorsal metacarpal artery and its cutaneous branch flap was used to repair the thumb defect is feasible and efficacy is good.Especially the operation could be completed in one time without increasing any other incisions.