双皮神经吻合局部带蒂皮瓣修复拇指缺损

Double cutaneous nerves anastomosed local pedicle flap for repair of thumb defect

[目的]介绍同侧双皮神经吻合带蒂皮瓣修复拇指软组织缺损的手术技巧和初步临床效果。[方法]2018年5月—2020年6月,对20例拇指指端或掌侧软组织缺损采用携带前臂外侧皮神经与桡神经浅支终末支的桡侧神经血管蒂皮瓣进行修复。清创后依据组织缺损大小与部位设计皮瓣。先切开皮瓣近侧缘,显露桡神经浅支终末支和前臂外侧皮神经,皮瓣携带2条皮神经,并保留轴线两侧宽约1.0 cm皮下筋膜组织的血管蒂。将皮瓣通过开放隧道转位覆盖远端创面,在显微镜下将皮瓣携带的2条皮神经与指固有神经残端进行端-端吻合,皮瓣供区直接缝合。[结果]20例患者块皮瓣全部成活。随访时间(12.20±1.70)个月。末次随访时拇指外形美观,桡侧供区仅残留线性瘢痕。皮瓣静态两点辨别觉为4~8 mm,平均(6.25±0.91)mm。[结论]相对于单一皮神经吻合带蒂皮瓣,双皮神经吻合的带蒂皮瓣修复拇指缺损技术可行,感觉恢复可能更好。

[Objective]To introduce the surgical technique and preliminary clinical results of double cutaneous nerves anastomosed local pedicle flap for repair of thumb defect.[Methods]From May 2018 to June 2020,a total of 20 patients received double cutaneous nerves anastomosed pedicle flap for repair of thumb tip or palmar defects.After debridement,the flap was designed according to the size and location of tissue defect.The proximal edge of the flap was firstly cut to expose the terminal branches of superficial radial nerve and the terminal ramus of the lateral cutaneous nerve of the forearm.As harvesting the flap,the 2 cutaneous nerves were labelled and cut off sharply with preservation of their distribution in the flap,which had vascular pedicle of subcutaneous fascia tissue about wide 1.0 cm retained.The flap was transferred to cover the distal wound by an open tunnel.Subsequently,the two cutaneous nerves were anastomosed end-to-end with the stumps of two digital nerves under microscope.The flap donor site was sutured directly.[Results]All the 20 patients had the flap survived,and followed up for(12.20±1.70)months.At the last follow-up,all the patients got the thumb in nice appearance,and only linear scar remained in the radial donor area.The static two-point discrimination of the flap ranged from 4 to 8 mm,with an average of(6.25±0.91)mm.[Conclusion]Compared with pedicle flap innervated by a single cutaneous nerve,this double-nerve-anastomosed local pedicle flap,including terminal branches of superficial radial nerve and the terminal ramus of the lateral cutaneous nerve of the forearm,is a feasible technique for repair of the thumb defect,should be conducive to sensory recovery.