[足母]甲皮瓣联合足底内侧动脉穿支皮瓣瓦合修复长手指脱套伤

Application of wrap-around great toe flap combined with medial plantar artery perforator flap for completely degloved fingers

目的探讨[足母]甲皮瓣联合足底内侧动脉穿支皮瓣(medial plantar artery perforator flap,MPAP)瓦合修复长手指脱套伤的疗效。方法2018年2月—2019年12月,收治12例机器绞伤导致的长手指脱套伤患者。男9例,女3例;年龄18-42岁,中位年龄32岁。伤指指别:示指7例,中指3例,环指2例。所有伤指掌指关节以远皮肤完全撕脱,肌腱及关节无缺损。受伤至入院时间1-8 h,平均5 h。急诊彻底清创后,皮肤缺损范围为8.0 cm×5.0 cm-12.0 cm×7.5 cm。切取同侧带感觉神经的[足母]甲皮瓣(8.0 cm×2.0 cm-12.0 cm×3.5 cm)和MPAP(8.0 cm×4.0 cm-12.0 cm×5.5 cm),制成超薄皮瓣瓦合修复手指。供区采用全厚皮片植皮或皮瓣修复。结果术后皮瓣及皮片全部成活,供、受区创面均Ⅰ期愈合。患者均获随访,随访时间12-16个月,平均14个月。患指质地、外观及色泽接近正常手指,指甲生长正常。末次随访时,伤指两点辨别觉为8-10 mm,平均9 mm;感觉均恢复至S3-S4,密歇根手部结果问卷(MHQ)评分达优10例、良2例。足部供区未出现行走疼痛、皮肤破溃等并发症,美国矫形足踝协会(AOFAS)评分达优9例、良3例。结论带感觉神经的[足母]甲皮瓣联合MPAP瓦合修复长手指脱套伤,手指外观、感觉及功能均恢复良好。

Objective To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap(MPAP) for repairing the completely degloved fingers. Methods Between February 2018and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted.There were 9 males and 3 females with a median age of 32 years(range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours(mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap(8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP(8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the fullthickness skin graft or the flap. Results All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months(mean,14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm(range, 8-10 mm), and the sensation of the injured finger recovered to S3-S4. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire(MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society(AOFAS) score was excellent in 9 cases and good in 3 cases. Conclusion Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.