吻合神经的同指对侧指背筋膜蒂皮瓣修复指侧方皮肤缺损

Application of dorsal fascial flap of the same finger with nerve anastomosis in the repair of finger lateral skin defects

目的探讨吻合神经的同指对侧指背筋膜蒂皮瓣修复指侧方皮肤缺损的手术方法及临床疗效。方法自2016年6月至2018年9月,苏州大学附属瑞华医院手外科对8例手指侧方皮肤缺损的患者采用同指对侧指背筋膜蒂皮瓣修复创面,术中保护好指背神经并移植于皮瓣内,再将指背神经断端与创面远端的神经断端相吻合。结果本组8例(8指)患者的移植皮瓣及指背植皮均成活,5例术后出现水疱,经抽吸减张后皮瓣颜色恢复红润,供受区伤口均一期愈合。术后随访6~24个月,平均10个月,皮瓣外观及质地较好,无明显色素沉着,蒂部不臃肿;皮瓣感觉恢复良好,两点辨别觉为10~12 mm。供区瘢痕不明显,关节活动良好,指背皮肤无明显感觉障碍。结论采用吻合神经的同指对侧指背筋膜蒂皮瓣修复手指侧方皮肤缺损可取得较满意的临床疗效。

Objective To explore the surgical method and clinical efficacy of dorsal fascial flap of the same finger with nerve anastomosis in the repair of finger lateral skin defects.Methods From June 2016 to September 2018,the wounds in 8 patients with finger lateral skin defects were repaired by dorsal fascial flap of the same finger.During the operation,the dorsal digital nerve was protected and transplanted into the flap.Then the broken end of the dorsal digital nerve was anastomosed with the broken end of the nerve at the distal end of the wounds.Results Eight cases of transplanted flaps and dorsal digital grafts survived.Five cases of flaps developed blisters after operation.After the blisters were drawn,the color of flaps was ruddy and the wounds healed in one stage.The follow-up was from 6 to 24 months,with an average of 10 months.The appearance and texture of the flap was good.No obvious pigmentation and swelling of the pedicle were found.The sensation of flap recovered well.The two-point discrimination was 10 to 12 mm.There was no obvious scar in the donor area.There was no obvious limitation in the movement of the joints and no obvious sensory disturbance in the dorsal finger skin.Conclusion The application of dorsal fascial flap of the same finger with nerve anastomosis in the repair of finger lateral skin defects can obtain satisfactory clinical efficacy.