两种不同类型的游离皮瓣修复指腹缺损的治疗效果比较分析

Comparative analysis of clinical efficacy of two different types of free skin flaps in the repair of finger pulp defects

目的比较两种不同类型的游离皮瓣修复指腹缺损的临床治疗效果。方法自2016年8月至2020年6月我们共收治44例(44指)指腹缺损患者,其中22例采用游离桡动脉掌浅支皮瓣修复(A组),22例采用游离趾腓侧皮瓣修复(B组)。两组患者术前一般资料比较,性别、年龄、创面面积差异均无统计学意义(P>0.05)。所有患者术后均得到有效随访。采用SPSS 24.0统计学软件比较分析两组的手术时间、术后6个月皮瓣的两点分辨觉、皮瓣感觉恢复情况及晚期功能恢复效果,以P<0.05为差异有统计学意义。结果术后随访时间为6.0~13.5个月,平均8.0个月,所有皮瓣术后均存活,临床治疗效果满意。A组手术时间为(168.06±66.18)min较B组(234.72±79.26)min短,差异有统计学意义(P<0.05)。术后6个月两组皮瓣的两点分辨觉比较,A组(6.87±1.26)mm大于B组(5.90±1.03)mm;皮瓣感觉恢复至正常情况的例数比较,B组为14例(63.64%)优于A组7例(31.82%),以上差异均有统计学意义(P<0.05)。术后6个月两组皮瓣晚期功能恢复的优良率比较,A组为90.91%(20/22例),B组为95.45%(21/22例),差异无统计学意义(P>0.05)。结论游离桡动脉掌浅支皮瓣手术时间较游离趾腓侧皮瓣短,但游离趾腓侧皮瓣修复指腹缺损的疗效优于游离桡动脉掌浅支皮瓣。

Objective To compare the clinical efficacy of two different types of free flaps for the repair of finger pulp defects.Methods From August 2016 to June 2020,44 patients(44 fingers)with finger pulp defects were treated,of which 22 cases were repaired with free superficial palmar branch of radial artery flap(Group A)and 22 cases were repaired with free toe fibular flap(Group B).There was no significant difference in gender,age and wound area between the two groups in preoperative general information(P>0.05).All the patients were followed up effectively.SPSS 24.0 statistical software was used to compare and analyze the operative time,two-point discrimination of the flap 6 months after operation,sensory recovery of the flap and late functional recovery between the two groups.The difference was statistically significant when the value of P was lower than 0.05.Results The follow-up time was 6.0 to 13.5 months,with an average of 8.0 months.All the flaps survived and the clinical treatment efficacy was satisfactory.The operation time in group A was(168.06±66.18)minutes,which was shorter than that in group B(234.72±79.26)minutes(P<0.05).At 6 months after operation,the two-point discrimination of the flap in group A(6.87±1.26)mm was greater than that in group B(5.90±1.03)mm.In comparison of the number of cases in which the flap sensation returned to normal,14 cases in group B(63.64%)were higher than 7 cases in group A(31.82%).The differences were statistically significant(P<0.05).At 6 months after operation,the excellent and good rate of late functional recovery of the two groups was 90.91%(20/22 cases)in group A and 95.45%(21/22 cases)in group B.There was no significant difference(P>0.05).Conclusion The operation time of free superficial palmar branch of radial artery flap is shorter than that of free toe fibular flap,but the clinical efficacy of free toe fibular flap is better than that of free superficial palmar branch of radial artery flap.