游离第二足趾胫侧皮瓣修复指尖皮肤软组织缺损

Application of free second toe tibial flap to repair the skin and soft tissue defects of fingertip

目的 探讨游离第二足趾胫侧皮瓣修复指尖皮肤软组织缺损的临床效果。方法 自2016年2月至2019年8月,中国人民解放军联勤保障部队第九八八医院全军创伤骨科中心采用游离第二足趾胫侧皮瓣修复11例指尖皮肤软组织缺损患者。其中拇指2例,示指4例,中指4例,环指1例。创面缺损面积1.2 cm×2.0 cm~2.0 cm×2.5 cm。皮瓣切取面积1.3 cm×2.2 cm~2.3 cm×2.8 cm,供区选择同侧第二足趾并移植全厚皮片。术后通过门诊复查方式,对皮瓣外形、感觉及供区恢复情况进行定期随访。结果 11例皮瓣全部成活,无血管危象发生,1例供区植皮部分坏死,给予换药后创面逐渐愈合。术后随访8~14个月,未发现供区明显功能障碍,受区皮瓣外形良好,感觉恢复至S2~S3+,两点辨别觉6~11 mm。手部功能恢复满意,根据中华医学会手外科学会上肢部分功能评定试用标准,优8例,良3例。采用温哥华瘢痕量表评估指尖瘢痕,评分3~5分,平均3.6分。结论 游离第二足趾胫侧皮瓣血管恒定,感觉恢复较好,供区隐蔽损伤较小,游离移植修复指尖创面效果良好。

Objective To investigate the clinical effect of free second toe tibial flap in repairing fingertip skin and soft tissue defects.Methods From February 2016 to August 2019,11 patients with fingertip skin and soft tissue defects were repaired with free second toe tibial flap at the Orthopaedic Trauma Center of PLA of The 988th Hospital of Joint Logistic Service of PLA.The area of soft tissue defec was 1.2 cm×2.0 cm to 2.0 cm×2.5 cm.The flap ranged from 1.3 cm×2.2 cm to 2.3 cm×2.8 cm.All donor site defects on the ipsilatera second toe were covered with full-thickness skin graft.There were 2 wounds in thumb,4 in index finger,4 in middle finger and 1 in ring finger.The wound defect area 1.2 cm×2.0 cm to 2.0 cm×2.5 cm.Skinflap cutting area 1.3 cm×2.2 cm to 2.3 cm×2.8 cm,the second toe on the same side of the donor site was selected and the full-thickness skin graft was transplanted.After the operation,the appearance,sensation and donor site recovery of the flap were regularly followed up by outpatient reexamination.Results All the flaps survived well in11 cases and without any vascular crisis.Partial skin graft necrosis at the donor site was found in 1 case,and the wound healed gradually after daily dressing change.After 8 to 14 months of follow-up,the appearance and the texture of the recipient site flap was good,and no obvious dysfunction of the donor site was found.Thesensation of the 11 flaps was recovered to S2 to S3+,and the two-point discrimination was 6 to 11 mm.The recovery of hand function was satisfactory.According to the trial criteria for evaluation of upper limb function of the Society of Hand Surgery of the Chinese Medical Association,8 cases were excellent and 3 cases were good.The Vancouver Scar Scale was used to evaluate the fingertip scar.The scores of 11 cases in this group were 3 to 5,with an average score of 3.6.Conclusion The free second toe tibial flap is a rational therapeutic strategy for repairing the skin and soft tissue defect of fingertip.It has the advantages of constant bloodvessels,good sensory recovery,and concealed donor area.