递进皮下蒂双V-Y皮瓣联合甲床扩大术修复甲床指端缺损

Progressive subcutaneous pedicle double V-Y flap combined with surgery of nail bed augmentation to repair the transverse defect of fingertip and nail bed defect

目的探讨递进式皮下蒂双V-Y皮瓣联合甲床扩大术修复部分甲床缺损的指端缺损的临床效果。方法自2015年6月至2019年6月对17例19指指端横断缺损伴甲床缺损的患者采用同指递进式皮下蒂双V-Y推进皮瓣联合甲床扩大术治疗。患指创面面积为1.0 cm×0.8 cm~1.6 cm×1.5 cm。随访观察术后伤指功能、外观,以及钩甲畸形发生率。结果术后随访8~24月,平均13个月。19指皮瓣全部成活,皮瓣感觉恢复达S4级。重建后指端呈弧形,手指外观满意,关节活动正常。指甲外观、质地良好;甲床长度平均增加3.3 mm(2~4 mm);均未出现钩甲畸形,指甲再生优良率为94%。结论递进式双V-Y皮瓣联合甲床扩大术修复伴甲床缺损的指端横断缺损,在重建指端及指甲外形的同时,减少了钩甲畸形的发生率,使伤指最大限度地恢复外形与功能,是一种疗效确切、便于操作的手术方法。

Objective To investigate the clinical effect of progressive subcutaneous pedicle double VY flap combined with nail bed augmentation in the repair the transverse defect of fingertip and partial nail bed defect.Methods From June 2015 to June 2019,17 patients with transverse defect of fingertip and nail bed defect were treated with progressive subcutaneous pedicle double V-Y flap combined with nail bed augmentation.The area of the affected finger wound was 1.0 cm×0.8 cm~1.6 cm×1.5 cm.The fingers were followed-up in function,appearance and incidence of hook nail deformity.Results The postoperative follow-up period was 8 to 24 months,13 months on average.All the 19 flaps survived well.The sensory recovery of 19 flaps reached S4 grade.The reconstructive fingers formed arc-shaped fingertips with nails of good appearance and texture.The appearance of the fingers was satisfactory and the joint movement was normal.The length of the nail bed increased by 2~4 mm,3.3 mm on average.There was no hook nail deformity in each finger.The excellent rate of nail regeneration was 94%.Conclusions Progressive subcutaneous pedicle double V-Y flap combined with nail bed augmentation can repair the transverse defect of fingertip and nail bed defect,and reduce the incidence of hook nail deformity while reconstructing the shape of fingertip and nail.It is an effective and simple surgical method for injured finger to reconstruct the shape and function to the maximum extent.