两种皮瓣移植治疗手指皮肤缺损的临床效果

Clinical Effect of Two Kinds of Skin Flap Transplantation in the Treatment of Finger Skin Defects

目的探究两种皮瓣移植治疗手指皮肤缺损的临床效果。方法回顾性分析2017年1月—2021年12月收治的102例手指皮肤缺损的临床资料,根据术式不同分为对照组(采用常规指背筋膜蒂岛状皮瓣移植)48例和观察组(采用吻合指动脉皮支的近节指背筋膜蒂岛状皮瓣移植)54例。观察2组皮瓣生存情况,比较2组皮瓣存活患者的围术期指标(手术时间、创面愈合时间、两点辨别觉)、外周血炎性因子水平[肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)]、手功能评分、手指总关节活动度以及并发症情况。结果术后7 d,对照组皮瓣存活42例(87.50%),观察组皮瓣存活53例(98.15%);观察组皮瓣存活率高于对照组(P<0.05)。观察组手术时间长于对照组,创面愈合时间和两点辨别觉短于对照组(P<0.05)。术后3 d,2组外周血TNF-α、IL-10水平均高于术前(P<0.05)。术后7 d,2组外周血TNF-α、IL-10水平均低于术前和术后3 d,且观察组低于对照组(P<0.05)。术后6个月,2组手功能评分和手指总关节活动度均高于术前,且观察组高于对照组(P<0.05)。术后,2组总并发症发生率比较差异无统计学意义(P>0.05),但观察组皮瓣暗紫发生率低于对照组(P<0.05)。结论吻合指动脉皮支的近节指背筋膜蒂岛状皮瓣移植能提高手指皮肤缺损患者的皮瓣存活率,加快创面愈合,改善手指功能,减轻术后炎症反应和并发症。

Objective To explore the clinical effect of two kinds of skin flap transplantation in the treatment of finger skin defects.Methods The clinical data of 102 patients with finger skin defects admitted from January 2017 to December 2021 were analyzed retrospectively.According to the different surgical methods,they were divided into the control group(48 cases were transplanted with the conventional dorsal digital fascial pedicle island flap)and the observation group(54 cases were transplanted with he island flap pedicled with dorsal fascia of proximal phalanx anastomosed with cutaneous branch of digital artery).The survival of skin flaps in the two groups were observed,and the perioperative indicators(duration of operation,wound healing time,two-point discrimination)and the level of peripheral blood inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)],hand function score,total range of motion(ROM)of the finger joint,and complications were compared between the two groups.Results At 7 d after operation,42 flaps survived in the control group(87.50%)and 53 flaps survived in the observation group(98.15%);the survival rate of skin flap in the observation group was higher than that in the control group(P<0.05).The duration of operation in the observation group was longer than that in the control group,while the wound healing time and two-point discrimination were shorter than those of the control group(P<0.05).At 3 d after operation,the levels of TNF-αand IL-10 in peripheral blood of the two groups were higher than those before operation(P<0.05).At 7 d after operation,the levels of TNF-αand IL-10 in peripheral blood of the two groups were lower than those before operation and at 3 d after operation,and lower in the observation group than in the control group(P<0.05).At 6 months after operation,the hand function score and the total ROM of the finger joint in both groups were higher than those before operation,and higher in the observation group than in the control group(P<0.05).After operation,there was no significant difference in the total complication rate between the two groups(P>0.05),but the incidence of dark purple skin flap in the observation group was lower than that in the control group(P<0.05).Conclusion The island flap pedicled with dorsal fascia of proximal phalanx anastomosed with cutaneous branch of digital artery can improve the survival rate of skin flap in patients with finger skin defect,accelerate wound healing,improve finger function,and reduce postoperative inflammatory reaction and complications.