游离(足母)趾腓侧皮瓣修复手指指腹软组织缺损

Free the first toe fibular skin flap to repair soft tissue defect of fingertip

目的探讨应用(足母)趾腓侧皮瓣游离移植修复手指指腹软组织缺损的临床疗效。方法 2015年1月-2019年6月,对20例手指指腹皮肤软组织缺损病例采用游离(足母)趾腓侧皮瓣游离移植修复。指腹软组织缺损面积:2.0cm×1.5cm~4.0 cm×3.5 cm。18例供区直接闭合,2例供区于小腿内侧取中厚皮片游离植皮。16例术后均获定期随访。结果本组20例皮瓣均成活,1例于术后24 h由于肿胀致缝线卡压血管蒂出现静脉血管危象,经拆线换药后解除危象,皮瓣成活。术后随访2~12个月,平均8个月,所有术指外形接近正常手指,皮瓣不臃肿,均有指螺纹,感觉恢复良好,两点辨别觉为5~8mm。所有术指功能恢复良好,根据中华医学会手外科学会手功能评定标准:优13例,良3例。(足母)趾供区创面均愈合良好,(足母)趾的外观及功能无明显影响。结论应用(足母)趾腓侧皮瓣游离移植修复手指指腹皮肤软组织缺损,皮瓣修复后外形饱满,质地良好,有螺纹,术后手指感觉、功能恢复良好,是一种理想的修复方法,值得临床推广。

Objective To explore the clinical effect of free transplantation of the first toe fibular skin flap to repair the soft tissue defect of the finger pulp.Methods From January 2015 to June 2019,Twenty cases with finger abdominal skin and soft tissue defects were freely repaired by transplantation of the first toe fibular flap.The area of soft tissue defect in the fingertips was from 2.0 cm×1.5 cm to 4.0 cm×3.5 cm.In all patients,18 donor sites were directly closed,and 2 donor sites were freed skin grafts with medium-thickness skin on the inner side of the lower legs.All 16 cases were followed up regularly after operation.Results Twenty flaps in this group survived.One case developed venous vascular crisis due to the swelling and compressed the vascular pedicle in 24 hours after the operation,the flap survived after the crisis through removing suture and dressing changed.The postoperative follow-up was 2 to 12 months,with an average of 8 months.All the fingers of the operation were similar to normal fingers,the flaps were not bloated,all had finger threads,and the feeling of recovery was good.The two-point discrimination was 5-8 mm.Function of all patients recovered well,according to the Society of Hand Surgery function evaluation standard issued by Chinese Medical Association:excellent in 13 cases,good in 3 cases.The wounds in the donor site of the first toe healed well,and the appearance and function of the toe were not significantly affected.Conclusion The first toe fibular skin flap was used to repair the skin and soft tissue defects of the fingertips,the skin flap has a full appearance,good texture,and ribs.The finger sensory and movement function recovered well after the operation.It is an ideal method and is worthy of clinical promotion.