带一侧指掌侧固有动脉的侧方V-Y推进皮瓣修复指端缺损27例

Repair of fingertip defect with lateral V-Y advancement flap with one side palmar proper digital artery:Report of 27 cases

目的探讨应用带一侧指掌侧固有动脉的侧方V-Y推进皮瓣修复指端缺损创面的方法及效果。方法2014年10月至2019年5月,济宁市第三人民医院(济宁市兖州区人民医院)手足外科对27例34指指端缺损面积0.5 cm×0.5 cm~1.5 cm×2.0 cm的患者采用带一侧指掌侧固有动脉的侧方V-Y推进皮瓣修复指端缺损,皮瓣大小为1.7 cm×1.0 cm~4.5 cm×1.5 cm。本组术后长期随访20例,7例失访,其中门诊随访16例,微信随访4例。结果本组27例34指皮瓣全部成活,皮瓣颜色与周围组织接近或完全正常,质地柔软,外观良好,皮瓣TPD 2.0~6.0 mm。随访时间22~77个月,平均31.45个月。手指屈、伸功能良好[拇指总关节活动度(ROM)>90°;手指主动运动总和(TAM)260°~200°],1例出现钩甲或钩指畸形。参照中华医学会手外科学会上肢部分功能评定试用标准:优18例,良2例。结论带一侧指掌侧固有动脉的侧方V-Y推进皮瓣操作简单易行,皮瓣血运可靠,皮瓣感觉良好,手指屈、伸活动良好,皮瓣外观及质地良好。

Objective To explore the method and effect in repairing the defect of fingertip with lateral V-Y advancement flap with one side palmar proper digital artery.Methods From October 2014 to May 2019,Department of the Hand and Foot Surgery,the Third People's Hospital of Jining(Yanzhou District People's Hospital of Jining City)treated 34 digits of 27 cases with a defect area of 0.5 cm×0.5 cm-1.5 cm×2.0 cm.A lateral V-Y advancement flap with one side palmar proper artery was used to repair the fingertip defect,and the flap size was 1.7 cm×1.0 cm-4.5 cm×1.5 cm.Twenty cases entered long-time follow-up after operation,with 7 cases lost in follow-up,16 cases were reviewed at outpatient and 4 by WeChat.Results All the flaps of 34 digits of 27 cases survived.The color of the flaps were close to or completely normal to the surrounding tissue,the texture was soft and the appearance was good.The TPD of the flap was 2.0-6.0 mm.The follow-up time ranged from 22 to 77 months,with an average of 31.45 months.The flexion and extension function of the digits were good with total range of motion(ROM)of the thumb was>90°;total active motion(TAM)of the fingers was 260°-200°.The fingers of 1 case had hook nail or hook finger deformity.According to the Evaluation Trial Standard of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association,18 cases were excellent and 2 cases were good.Conclusion The lateral V-Y advancement flap with one side palmar proper digital artery is easy to operate.The blood supply of the flap is reliable,with good sensation.The flexion and extension of the digits are good,and the appearance and texture of the flap are good.