不携带静脉游离踇趾腓侧皮瓣修复手指指腹缺损疗效分析

Clinical effect of free fibular flap without vein of great toe in repairing soft tissue defect of finger pulp

目的探讨不携带静脉的游离踇趾腓侧皮瓣修复手指指腹缺损的临床疗效.方法2020年6月至2021年1月,采用不携带静脉的踇趾腓侧游离皮瓣修复手指指腹缺损8例,其中男6例,女2例,平均年龄32(18~42)岁,患指指腹缺损面积1.0 cm×0.5 cm~1.8 cm×0.8 cm,术中切取踇趾腓侧皮瓣仅携带趾底动脉及趾底神经,吻合和缝接患指指掌侧固有动脉及指掌侧固有神经,所有皮瓣均未携带回流静脉,足趾供区直接拉拢缝合,术后常规抗感染、抗痉挛、抗凝治疗.术后门诊定期随访.结果术后皮瓣全部成活,均未发生血管危象,供、受区术口均Ⅰ期愈合.8例患者均得到随访,平均随访时间6.4(4~12)个月.患指指腹外形饱满,质地、弹性良好,末次随访时TPD达6~8 mm,按中华医学会手外科学会上肢部分功能评定试用标准评价手功能,获优7例,良1例.结论游离踇趾腓侧皮瓣对于修复手指指腹微小创面,可以不携带回流静脉使皮瓣成活,对于在解剖分离回流静脉失败的病例中提供一定的参考意义.

Objective To investigate the clinical effect of free fibular flap of great toe without vein in repairing soft tissue defect of finger pulp.Methods From June 2020 to January 2021,8 cases of finger pulp soft tissue defect were repaired with free flap of fibular side of great toe without vein,including 6 males and 2 females,with an average age of 32(18-42)years old.The defect area of finger pulp was 1.0 cm×0.5 cm-1.8 cmx0.8 cm.The proper digital artery and digital nerve of the affected finger were anastomosed.All flaps did not carry reflux veins.The donor site of the toe was directly sutured.Postoperative routine anti infection,anti spasm and anticoagulant treatment was performed.Postoperative outpatient regular follow-up.Results All flaps survived without vascular crisis,and the donor and recipient sites healed in the first stage.All patients were followed-up for an average of 6.4(4-12)months.At the last follow-up,the TPD was 6-8 mm,the hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Hand Surgery Society of Chinese Medical Association.Seven cases were excellent and 1 case was good.Conclusion The free fibular flap of the great toe can be used to repair the small wound of finger pulp without carrying the draining vein,the flap can still survive.And it can provide a certain reference for the failure of anatomic separation of the draining vein.