指侧方皮瓣修复术与静脉皮瓣修复术治疗伴皮肤缺损断指再植患者的效果比较

Comparison of effects of lateral digital flap repair and venous flap repair in treatment of patients with skin defect undergoing replantation of amputated fingers

目的:比较指侧方皮瓣修复术与静脉皮瓣修复术治疗伴皮肤缺损(SD)断指再植患者的效果。方法:回顾性分析2019年4月至2022年4月该院收治的108例伴SD断指再植患者的临床资料,根据手术方案不同将其分为对照组和观察组各54例。对照组实施静脉皮瓣修复术治疗,观察组实施指侧方皮瓣修复术治疗,比较两组手术优良率、术后3个月损指功能评分、损指感觉功能修复情况、炎性因子[白细胞介素-6(IL-6)、γ-干扰素(IFN-γ)]水平、血清学指标[碱性成纤维细胞生长因子(bFGF)、表皮生长因子(EGF)、转化生长因子-β_(1)(TGF-β_(1))]水平及并发症发生率。结果:两组手术优良率比较,差异无统计学意义(P>0.05);术后3个月,观察组损指血液循环、日常活动、关节自主活动度及外观评分均高于对照组,差异有统计学意义(P<0.05);两组损指触觉功能修复率比较,差异无统计学意义(P>0.05);观察组热觉、痛觉、冷觉功能修复率均高于对照组,差异有统计学意义(P<0.05);术后1、3个月,两组IL-6水平均低于术前,且观察组低于对照组,两组IFN-γ水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);术后1、3个月,两组血清bFGF、EGF、TGF-β_(1)水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为3.70%,低于对照组的16.67%,差异有统计学意义(P<0.05)。结论:指侧方皮瓣修复术与静脉皮瓣修复术治疗伴SD断指再植患者的手术优良率相当,但指侧方皮瓣修复术可提高热觉、痛觉、冷觉功能修复率,损指功能评分,血清学指标水平,改善炎性因子水平,降低并发症发生率的效果优于静脉皮瓣修复术治疗。

Objective:To compare effects of lateral digital flap repair and venous flap repair in treatment of patients with skin defect(SD)undergoing replantation of amputated fingers.Methods:The clinical data of 108 patients with SD undergoing replantation of amputated fingers admitted to the hospital from April 2019 to April 2022 were retrospectively analyzed.According to different surgical schemes,they were divided into control group and observation group,54 cases in each group.The control group was treated with venous flap repair,while the observation group was treated with lateral digital flap repair The excellent and good rate of operation,the recovery index score of the injured finger 3 months after the surgery,the sensory function of the injured finger,the levels of inflammatory factors[interleukin-6(IL-6),inte rferon-γ(IFN-γ)],the serological index levels[fibroblast growth factor(bFGF),human epidermal growth factor(EGF),transforming growth factor-β_(1)(TGF-β_(1))],and the incidence of complications were compared between the two groups.Results:There was no significant difference in the excellent and good rate between the two groups(P>0.05).3 months after the surgery,the blood circulation,the daily activities,the joint autonomous activity and the appearance scores of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).The thermal sensation,the pain sensation and the cold sensation function of the observation group were better than those of the control group,and the difference was statistically significant(P<0.05).1 and 3 months after the surgery,the levels of IL-6 in the two groups were lower than those before the surgery,and those in the observation group were lower than those in the control group;the levels of IFN-γ in the two groups were higher than those before the surgery,and those in the observation group were higher than those in the control group;and the difference was statistically significant(P<0.05).1 and 3 months after the surgery,the levels of serum bFGF,EGF and TGF-β_(1) in the two groups were higher than those before the surgery,those in the observation group were higher than the control group,and the differences were statistically significant(P<0.05).The observation group had lower incidence of complications of 3.70% than 16.67% in the control group,and the difference was statistically significant(P<0.05).Conclusions:The excellent and good rates of lateral digital flap repair and venous flap repair in the treatment of the patients with SD undergoing replantation of amputated fingers are similar,but the former can improve the scores of thermal sensation,the pain,the cold sensation function,the damage index scores and the serological index levels,improve the levels of inflammatory factors,and reduce the incidence of complications.Moreover,it is superior to venous flap repair.