复合远端蒂掌背皮瓣治疗指背软组织缺损23例

23 Cases Clinical Report on Composite Distal Pedicle Dorsal Metacarpal Flap on the Treatment of Finger Dorsal Tissue Defects

目的:探讨复合远端蒂掌背皮瓣治疗指背软组织缺损的临床疗效。方法:自2017年6月至2020年8月,采用复合远端蒂掌背皮瓣(包含掌背动脉和皮神经)修复手指背软组织缺损患者23例。创面面积:3.8cm×2.1cm~5.3cm×3.6cm,皮瓣面积:4.0cm×2.5cm~6.0cm×4.0cm。结果:本组23例全部成活,其中3例术后2~3d内皮瓣远端出现张力性水疱,部分表皮坏死,拆除部分缝线换药后愈合;余者皮瓣及供区切口均一期愈合。随访时间3~15个月(平均6.3个月)。皮瓣颜色外观与受区周围皮肤类似,饱满无臃肿,皮瓣弹性好。皮瓣两点辨别觉8~11mm,平均9.7mm。按照总主动活动度(Total Active Movement,TAM)功能测定法评定:功能恢复为优13例,良9例,可1例。患者预后与损伤的程度相关。供区瘢痕无溃疡、触痛等并发症。结论:复合远端蒂掌背皮瓣适合用于手指背较大创面的修复;术中选择灵活性强,可避免因掌背血管或皮神经解剖变异而放弃手术;便于基层医院开展。

Objective:To explore the clinical efficacy of compound distal pedicle dorsal metacarpal flap.Methods:23cases with soft tissue defects of the fingers repaired by composite distally-based retrograde dorsal metacarpal flaps(includes the dorsal metacarpal artery and dorsal neurocutaneous)from June 2017to August 2020were included.The defect size varied from 3.8cm×2.1cm to 5.3cm×3.6cm.The flap size varied from 4.0cm×2.5cm to 6.0cm×2.5cm.Results:All flaps in this group survived,of which 3cases developed tension blisters and partial epidermal necrosis at the distal end of the endothelial flap 2to 3dafter operation,and healed after removing some sutures and dressing changes.The remaining flaps and the donor area incision were healed initially.The follow-up time was 3to 15months,with an average of 6.3 months.The color appearance of the flaps was similar to the skin surrounding the area,full and not bloated and good cosmetic,and the texture were good elastic.The flap two-point discrimination perception was 8to 11mm with mean of 9.7mm.Functional recovery were evaluated according to TAM(total active movement)function determination method showed:13cases excellent,9good and 1fair,and it was associated with the degree of the injury.The donor area scar had no ulcer,tactile pain and other complications.Conclusion:The dorsal metacarpal flap with compound distal pedicle is suitable for repairing large wounds on the dorsal finger.The intraoperative choice is flexible,avoiding giving up the operation due to anatomical variation of dorsal metacarpal vessels or cutaneous nerves,which is convenient for grass-roots hospitals.