大鱼际皮瓣转位修复拇指指腹缺损

The thenar flap transposition repair for the defect of thumb pulp

目的探讨大鱼际皮瓣转位修复拇指指腹缺损的临床效果,观察供区人工真皮修复后愈合情况。方法采用大鱼际皮瓣转位修复38例拇指指腹缺损伴骨肌腱外露,供区应用人工真皮修复。缺损面积2.0 cm×1.3 cm^3.0 cm×1.8 cm,皮瓣切取面积2.2 cm×1.5 cm^3.2 cm×2 cm。结果38例皮瓣全部成活。患者均获得随访,时间1~2年。供区人工真皮覆盖处理后3~5周创面愈合,远期瘢痕较轻,挛缩不明显。术后1年皮瓣区两点分辨觉4~8 mm。末次随访时,35例拇指指腹外观良好,经功能锻炼后拇指活动恢复良好,精细动作满意;2例皮瓣较臃肿,但拇指活动恢复良好;1例在寒冷时出现修复区怕冷,但未出现修复区冻伤现象,拇指活动恢复不理想,精细动作不满意。结论大鱼际皮瓣转位修复拇指指腹缺损疗效良好,皮瓣血运可靠,供区人工真皮覆盖处理后愈合良好。

Objective To investigate the clinical effect of transposition of thenar flap for repairing thumb pulp defect,and to observe the healing condition of donor site artificial dermis.Methods The 38 cases of thumb pulp defects with bone and tendon exposure were repaired with thenar flap transposition,and the donor site was repaired with artificial dermis.The defect area was 2.0 cm×1.3 cm^3.0 cm×1.8 cm,and the area of cut flap was 2.2 cm×1.5 cm^3.2 cm×2 cm.Results All 38 cases of flaps survived.All patients were followed up for 1~2 years.The wound healed within 3~5 weeks following the covering management of artificial dermis in the donor site,the long-term scar was light,and the contracture was not obvious.The two-point discrimination of flap area was 4~8 mm at 1 year postoperation.At the last follow-up,the thumb pulp appearances of the 35 cases were good,and the thumb function were restored well after functional exercise,fine movements were satisfactory;2 cases of flaps were swollener,one of them was afraid of cold,while there was no frostbite in the repair area,the recovery of thumb motion was not ideal,and the fine movement wasn′t satisfactory.Conclusions The transposition of thenar flap for repairing thumb pulp defect has good therapeutic effect and reliable blood supply,the donor site heal well after being covered with artificial dermis.