比较指固有动脉侧方血管链皮瓣和指固有动脉岛状皮瓣修复手指软组织缺损的疗效

A comparison of clinical efficacy of lateral vascular chain flap of the proper digital artery and island flap of the proper digital artery in repairing soft tissue defect of finger

目的比较指固有动脉侧方血管链皮瓣和指固有动脉岛状皮瓣修复手指软组织缺损的临床疗效。方法 950例手指软组织缺损患者分别行指固有动脉侧方血管链皮瓣(试验组,649例)和指固有动脉岛状皮瓣修复手术(对照组,301例),比较两种术式的治疗效果。结果 950例指皮瓣全部存活。试验组28例和对照组12例在术后1~3 d出现水泡,未予特殊处理自行吸收。试验组12例和对照组5例指皮瓣指出现静脉危象,经对症处理后缓解。术后随访12个月:试验组修复创面后与受区周围皮肤颜色相近,皮瓣质地柔软,有弹性,外形满意;对照组20例因出现指端皮肤臃肿、冗厚,呈"火柴头样"改变,外观较差;对照组60例出现了患指冬季畏寒和冻疮并发症。两组指腹综合质地感觉、Anderson功能、手指两点辨别觉、指间关节活动度、VAS疼痛评分无统计学差异(P>0.05)。试验组皮瓣感觉恢复情况优于对照组(P<0.05)。结论相较于指固有动脉岛状皮瓣,指固有动脉侧方血管链皮瓣修复手指软组织缺损具有损伤小、耐寒性好、外观美观、感觉恢复好等优点。

Objective To compare the clinical efficacy of lateral vascular chain flap of the proper digital artery and island flap of the proper digital artery in repairing the soft tissue defect of the finger.Methods A total of 950 patients with soft tissue defect of the finger underwent repairing surgery of lateral vascular chain flap of the proper digital artery(group A,649 cases) or island flap of the proper digital artery(group B,301 cases).The clinical efficacy was compared between the two groups.Results All finger skin flaps were survived.Twenty-eight patients of group A and 12 patients of group B developed blisters 1 to 3 days after operation, which were absorbed without treatment.Twelve patients of group A and 5 patients of group B showed venous crisis with finger skin flaps, which were relieved after symptomatic treatment.The patients were followed up for 12 months.The skin color was similar to that of the surrounding area, and the skin flap was soft, elastic and satisfactory in shape in group A.Twenty patients of group B had bloated and redundant fingertip skin, which was changed like "match head" and had poor appearance.Sixty patients were complicated with chills and chilblains in winter.There were no significant differences between the two groups in the fingerprint comprehensive texture sensation, Anderson function, finger two-point discrimination, interphalangeal joint motion and VAS pain scores(P>0.05).The flap sensory recovery was better in group A than that in group B(P<0.05).Conclusion Compared with the island flap of the proper digital artery, repairing the finger soft tissue defects with the lateral vascular chain flap of the proper digital artery has the advantages of less injury, better cold tolerance, beautiful appearance and better flap sensory recovery.