第一掌骨背侧-大鱼际联合逆行皮瓣在修复拇指末节皮肤缺损中的应用

Effect of dorsal metacarpal-thenar junction flap in repairing skin defect of distal segment of thumb

目的探讨应用第一掌骨背侧-大鱼际联合逆行皮瓣修复拇指较大面积缺损的效果。方法2018年1月—2019年12月哈尔滨市第五医院手外科收治5例拇指末节皮肤缺损患者,男性3例,女性2例,年龄22~50岁,平均36.8岁。其中末节脱套伤2例,末节离断伤2例,末节掌侧撕脱伤1例,缺损面积为7.0cm×5.0cm~4.0cm×5.0cm。采用第一掌骨桡背侧筋膜蒂皮瓣联合切取鱼际区逆行皮瓣修复,观察皮瓣外观、质地,供区瘢痕情况及感觉恢复、指腹胼胝体形成情况。结果患者均随访6~12个月,平均9.6个月。患者均皮瓣外观良好,质地接近正常皮肤,无破溃发生。拇指末节皮肤可见皮纹,尺掌侧均可见少许胼胝体形成。其中供瓣区3例直接缝合,2例行中厚断层皮片移植,供瓣区均恢复良好。修复效果按中华医学会手外科学会上肢部分功能评定试用标准评定优4例,良1例。按英国医师协会感觉评分,感觉恢复至S32例,S43例。结论将第一掌骨背侧逆行皮瓣与大鱼际区逆行皮瓣联合切取,手术操作简单,在同一麻醉下、同一术区内即可完成,桡背侧修复拇指背侧,鱼际区修复尺掌侧,修复后的拇指可获得背侧的保护性感觉及掌侧的耐磨性角质皮肤,是一种理想的适合拇指较大面积组织缺损修复的方式。

Objective To explore the effect of repairing large skin defect of distal segment of thumb with dorsal metacarpal-thenar junction flap.Methods From Jan.2018 to Dec.2019,five patients were treated in The Fifth Hospital of Harbin,including 3 males and 2 females,aged from 22 to 50 years,with an average of 36.8 years.There were 2 cases of distal degloving injury,2 cases of distal amputation injury and 1 case of distal metacarpal avulsion injury.The defect area was 7.0cm×5.0cm-4.0cm×5.0cm.The thumb dorsal radial fasciocutaneous flap combined with retrograde thenar flap was used for repair.The appearance and texture of the flap,the scar of the donor site and the formation of the corpus callosum of the fingertip were observed.Results All cases were followed up for 6-12 months,and the average follow-up time was 9.6 months.In all cases,the appearance of the skin flap was good,the texture was close to the normal skin,no ulceration occurred,the skin lines of the distal part of the thumb and a little corpus callosum could be seen on the ulnar and palmar side.Among them,3 cases were sutured directly in the donor area,and 2 cases were treated with medium-thickness sectional skin graft.All the donor areas recovered well.The effect was good according to the upper limb function evaluation standard of Hand Surgery Association of Chinese Medical Association:excellent in 4 cases and good in 1 case.According to the sensory score of the British Association of Physicians,the sensation recovered to S3 in 2 cases and S4 in 3 cases.Conclusion The operation is simple and can be completed under the same anesthesia and in the same operation area.The dorsal radial side of the thumb and the thenar area can be repaired in the same area.The repaired thumb can obtain the protective sensation of the dorsal side and the wear-resistant cuticular skin of the palmar side.It is an ideal method for repairing large tissue defect of the thumb.