指侧方皮瓣和静脉皮瓣修复在伴有皮肤缺损的断指再植手术中的应用效果比较

Comparison of the application effect between laterodiatal flap repair and venous flap repair in the severed finger replantation with skin defects

目的探讨指侧方皮瓣和静脉皮瓣修复在伴有皮肤缺损的断指再植手术中的应用效果,为临床治疗提供依据。方法选择我院2016年6月~2019年4月收治的72例伴有皮肤缺损的断指再植患者作为研究对象,所有患者均行皮瓣修复手术治疗,根据皮瓣选择的不同将患者分为静脉皮瓣修复治疗组(对照组)和指侧方皮瓣修复治疗组(观察组),各36例,观察两组患者的手术优良率、术后并发症情况,并根据Tamai功能评分标准对术后手外观及功能进行评价,手术后对两组患者进行随访。结果观察组和对照组手术效果优良率分别为94.4%和91.7%,组间差异无统计学意义(P>0.05);观察组患者术后皮瓣弹性变差及颜色加深的发生率分别为2.8%和5.6%,明显低于对照组患者的19.4%和25.0%,组间差异有统计学意义(P<0.05);根据Tamai功能评分标准,观察组患者术后主观感觉及外观评分分别为(16.29±2.26)分和(18.25±2.13)分,高于对照组患者的(14.22±1.69)分和(16.80±2.52)分,组间差异有统计学意义(P<0.05)。结论指侧方皮瓣和静脉皮瓣修复应用于伴有皮肤缺损的断指再植手术均能取得较好的疗效,但指侧方皮瓣在术后感觉、外观改善及降低并发症发生率方面优于静脉皮瓣,临床可根据实际情况选择合理的皮瓣修复方式。

Objective To explore the application effect between laterodiatal flap repair and venous flap repair in the severed finger replantation with skin defects so as to provide basis for clinical treatment.Methods 72 patients suffered from severed finger with skin defects admitted to and treated in our hospital for severed finger replantation from June2016 to April 2019 were selected as the subjects of research.All the patients were treated with skin flap repair surgeries.According to the different choices of flaps,the patients were divided into the venous flap repair treatment group(the control group)and the laterodiatal flap repair treatment group(the observation group),with 36 patients in each group.The excellence rate of surgery and the postoperative complications of the two groups were observed,and the postoperative appearance and functions of the hand were evaluated according to Tamai function score criteria.After surgery,the two groups were followed up.Results The excellence rate of surgical effect on the patients of the observation group and the control group was 94.4%and 91.7%respectively,and there was no statistically significant difference between the two groups(P>0.05).The incidence of elasticity deterioration and color deepening of skin flap of the patients in the observation group after operation was 2.8%and 5.6%respectively,significantly lower than the 19.4%and25.0%of the patients in the control group,and the differences between the two groups were statistically significant(P<0.05).According to Tamai function score criteria,the subjective sensation and appearance scores of the patients in the observation group after operation were(16.29±2.26)points and(18.25±2.13)points respectively,which were higher than the(14.22±1.69)points and(16.80±2.52)points of the patients in the control group,and the differences between the two groups were statistically significant(P<0.05).Conclusion Both the laterodiatal flap repair and venous flap repair can achieve good curative results in the severed finger replantation with skin defects,but the laterodiatal flap repair is superior to the venous flap repair in the patients’postoperative sensation,the improvement of appearance and the reduction of the incidence of complications.In clinical practices,a reasonable method of flap repair can be selected according to the actual situation.