拇指桡侧指动脉逆行近节背侧皮瓣修复拇指指端缺损

Reverse proximal dorsal island flap pedicled with the radial digital artery of the thumb for repair of thumb tip defects

目的探讨拇指桡侧指动脉逆行近节背侧皮瓣修复拇指指端缺损的临床疗效。方法采用回顾性病例系列研究分析2010年2月至2020年10月河北省任丘市人民医院收治的56例拇指指端缺损患者的临床资料,其中男37例,女19例;年龄17~66岁[(37.8±12.2)岁]。右侧35例,左侧21例。均伴有拇指末节指骨外露。缺损面积为2.9 cm×1.8 cm~3.3 cm×2.6 cm。均切取拇指桡侧指动脉逆行近节背侧皮瓣,携带指背神经与指固有神经断端吻合。供区取患侧前臂尺侧中厚皮片游离植皮修复。记录手术过程中的皮瓣切取时间和手术时间。观察皮瓣成活情况、供区愈合情况。末次随访时观察皮瓣外形、质地、感觉恢复情况及并发症情况。术后1个月及末次随访时采用中华医学会手外科学会上肢部分功能评定试用标准与温哥华瘢痕量表(VSS)评分评估皮瓣感觉功能恢复与供区瘢痕形成情况。结果患者均获随访6~26个月[(13.2±6.4)个月]。皮瓣切取时间为20~35 min[(26.0±5.3)min]。手术时间为1~2 h[(1.3±0.3)h]。术后2例皮瓣远端出现水疱,未做处理,术后7 d水疱自行消退,皮瓣成活。其余皮瓣均顺利成活。供区均Ⅰ期愈合。末次随访时皮瓣外形较美观,质地、弹性及颜色与周围皮肤相似,皮瓣感觉恢复良好。供区无瘢痕挛缩和指间关节屈伸障碍。末次随访时中华医学会手外科学会上肢部分功能评定试用标准,56例均超过S3级,高于术后1个月的0例(P<0.01)。VSS评分为3~7分[(5.0±1.4)分],低于术后1个月的6~12分[(8.8±1.5)分](P<0.01)。供区为线状瘢痕,其外形及功能未受明显影响。结论拇指桡侧指动脉逆行近节背侧皮瓣修复拇指指端缺损,皮瓣切取方便,容易成活,外形及功能恢复良好,且供区损伤小。

Objective To investigate the therapeutic effect of reverse proximal segment dorsal flap of radial digital artery of the thumb in repairing thumb tip defects.Methods A retrospective case series study was conducted to analyze the clinical data of 56 patients with thumb tip defects admitted to Renqiu People's Hospital from February 2010 to October 2020.There were 37 males and 19 females,aged 17-66 years[(37.8±12.2)years].The injury on the right side was observed in 35 patients and on the left side in 21 patients.All of them were thumb tip defects with exposed distal phalanx.Dimension of skin defects was 2.9 cm×1.8 cm-3.3 cm×2.6 cm.The reverse proximal segment dorsal flap of thumb radial digital artery was used,with the dorsal digital nerve sutured with the proper digital nerve.The donor site was repaired with free skin graft from the ulnar side of the affected forearm.The time of flap harvesting,operation time and healing of the flap were measured.At the last follow-up,the shape,texture,sensory recovery and complications of the flap were observed.One month after operation and at the latest follow-up,the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association and Vancouver Scar Scale(VSS)score were used to evaluate the recovery of sensory function of the flap and scar formation of the donor sites,respectively.Results All patients were followed up for 6-26 months[(13.2±6.4)months].The time of flap harvesting ranged from 20 to 35 minutes[(26.0±5.3)minutes].The operation time was 1-2 hours[(1.3±0.3)hours].Blisters appeared at the distal end of the flap in 2 patients after operation,but they were not treated.After 7 days,the blisters subsided and the flaps survived.The other flaps survived successfully.The donor sites healed by first intention.At the last follow-up,the flaps showed relatively cosmetic appearance,similarities in texture,elasticity and color to the surrounding area and good sensory recovery,without scar contracture and dystrophy of interphalangeal joint.According to the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association,56 patients exceeded S3 grade compared to none at postoperative 1 month(P<0.01),and the VSS score was 3-7 points[(5.0±1.4)points]compared to 6-12 points[(8.8±1.5)points]at postoperative 1 month(P<0.01).The donor site left a linear scar,which had no significant effect on its shape and function.Conclusion The reverse proximal segment dorsal flap of the radial digital artery of the thumb can be used to repair thumb tip defects,for it has advantages of easy operation,a high survival rate as well as good appearance and sensory function recovery,with less damage to the donor area.