带部分拇短伸肌腱的桡侧指背动脉皮瓣修复拇指背侧复合组织缺损

Clinical application of radial dorsal digital artery flap with part short thumb extensor tendon in repairing dorsal skin defects of the thumb

目的探讨采用带部分拇短伸肌腱的桡侧指背动脉皮瓣修复拇指背侧复合组织缺损的临床疗效。方法回顾性分析2018年8月至2020年8月无锡市第九人民医院手外科收治的拇指背侧复合软组织缺损患者的临床资料, 均利用带部分拇短伸肌腱的桡侧指背动脉皮瓣修复, 并重建伸肌腱止点。术后随访观察皮瓣质地、外形、运动功能以及感觉恢复情况;测量皮瓣的两点辨距觉、感觉恢复度及拇指屈伸活动度;根据中华医学会手外科学分会手部肌腱修复后评定标准评定手功能。结果共纳入10例患者, 男6例, 女4例, 年龄20~67岁, 平均41岁, 左手6例, 右手4例。皮肤软组织缺损面积最小2.0 cm×1.5 cm, 最大3.0 cm×2.5 cm, 肌腱缺损范围1.0 ~1.7 cm。均采用带部分拇短伸肌腱的桡侧指背动脉皮瓣一期修复, 皮瓣切取范围2.5 cm× 1.8 cm~3.5 cm× 3.0 cm, 拇短伸肌腱切取长度为2.0~3.4 cm。术后10例皮瓣全部存活, 创面一期愈合。患者均获6~12个月随访, 平均8个月, 术后手指外形满意, 外观良好, 质地柔软;皮瓣两点辨距觉为7~10 mm, 平均9 mm, 感觉恢复至S3级;对指、对掌功能正常, 拇指屈伸活动度为60°~90°。拇指功能评定:优8例, 良2例。供区愈合良好, 外观满意。结论带部分拇短伸肌腱的桡侧指背动脉皮瓣可一期修复拇指皮肤和肌腱缺损, 并具有切取简单、供区损伤小、血供可靠及皮瓣外观、感觉和功能恢复满意等优点, 是修复拇指背侧复合组织缺损的较好方法。

Objective To investigate the effectiveness of radial dorsal digital artery flap with part short thumb extensor tendon in repairing dorsal skin defects of the thumb.Methods The clinical data of patients with thumb wounds complicated with extensor tendon defect who were repaired with radial dorsal digital artery flap with part short thumb extensor tendon in the Department of Hand Surgery,Wuxi No.9 People's Hospital from August 2018 to August 2020 were analyzed retrospectively.After the operation,the shape and function of the thumb were followed up by testing the two-point discrimination of chimeric flap,the sensory function and the thumb opposition function.The function of the thumb was evaluated with the reference of the total active movement(TAM)of fingers of the Chinese Medical Association Hand Surgery Branch.Results A total of 10 cases with soft tissue defect of thumb were treated,whose tendon defect ranged 1.0-1.7 cm in length.There were 6 males and 4 females,aged from 20 to 67 years(mean,41 years).The left hand was involved in 6 cases and the right in 4 cases.Radial dorsal digital artery flap with part short thumb extensor tendon were used to reconstruct extensor tendon and wound with the size of 2.0 cm×1.5 cm-3.0 cm×2.5 cm.The size of flap harvest was 2.5 cm×1.8 cm-3.5 cm×3.0 cm,and the tendon was 2.0-3.4 cm in length.All flaps in 10 patients were survived with primary healing.All patients were followed-up from 6 to 12 months,with the average of 8 months.Flaps presented good appearance and color,pliability.The two-point discrimination of chimeric flap was 7-10 mm(mean,9 mm),and the thumb opposition function was good.The flap sensory function reached S3.The interphalangeal joint flexion of thumb was 60°-90°,and the thumb opposition function was good.According to the total active movement system,excellent result was achieved in 8 cases and good in 2 cases.Conclusions Radial dorsal digital artery flap with part short thumb extensor tendon was an ideal clinical method for repair of dorsal skin defects of the thumb,which can repair skin and tendon defects in one stage.The operation is simple with reliable blood supply.This method could also restore the appearance and function of fingers.