带神经血管束鹿角形皮瓣修复手指指端缺损

Clinical application of neurovascular staghorn flap for repairing of defects in fingertips

目的探讨应用带神经血管束鹿角形皮瓣修复手指指端缺损的临床疗效。方法2019年8月—2021年10月,采用带神经血管束鹿角形皮瓣修复15例15指手指指端缺损。男8例,女7例;年龄28~65岁,平均44岁。致伤原因:机器碾压伤8例,重物砸压伤4例,切割伤3例。其中拇指1例,示指5例,中指6例,环指2例,小指1例。急诊12例,外伤缝合后指端坏死3例。创面均有骨或肌腱外露,指端缺损范围为1.2 cm×0.8 cm~1.8 cm×1.5 cm,皮瓣切取范围2.0 cm×1.5 cm~2.5 cm×2.0 cm。皮瓣供区均直接拉拢缝合。结果术后皮瓣全部成活,无感染或坏死发生,切口均Ⅰ期愈合。15例患者均获随访,随访时间6~12个月,平均10个月。末次随访时皮瓣外观满意,耐磨性好,颜色与指腹皮肤接近,无臃肿;皮瓣两点辨别觉为3~5 mm。1例出现掌侧线性瘢痕挛缩,屈伸略受限,对功能影响较小;其余患者瘢痕挛缩不明显,手指屈伸可,无功能障碍。按中华医学会手外科学会手指关节总活动度(TAM)系统评定方法评价手指功能,获优13例,良2例。结论应用带神经血管束鹿角形皮瓣修复手指指端缺损,操作简单,皮瓣成活可靠,与创面契合度高,不浪费皮肤,术后手指外形和功能满意。

Objective To evaluate the effectiveness of neurovascular staghorn flap for repairing defects in fingertips.Methods Between August 2019 and October 2021,a total of 15 fingertips defects were repaired with neurovascular staghorn flap.There were 8 males and 7 females with an average age of 44 years(range,28-65 years).The causes of injury included 8 cases of machine crush injury,4 cases of heavy object crush injury,and 3 cases of cutting injury.There were 1 case of thumb,5 cases of index finger,6 cases of middle finger,2 cases of ring finger,and 1 case of little finger.There were 12 cases in emergency,and 3 cases with finger tip necrosis after trauma suture.Bone and tendon exposed in all cases.The range of fingertip defect was 1.2 cm×0.8 cm to 1.8 cm×1.5 cm,and the range of skin flap was2.0 cm×1.5 cm to 2.5 cm×2.0 cm.The donor site was sutured directly.Results All flaps survived without infection or necrosis,and the incisions healed by first intention.All patients were followed up 6-12 months,with an average of 10months.At last follow-up,the appearance of the flap was satisfactory,the wear resistance was good,the color was similar to the skin of the finger pulp,and there was no swelling;the two-point discrimination of the flap was 3-5 mm.One patient had linear scar contracture on the palmar side with slight limitation of flexion and extension,which had little effect on the function;the other patients had no obvious scar contracture,good flexion and extension of the fingers,and no dysfunction.The finger function was evaluated according to the total range of motion(TAM)system of the Hand Surgery Society of Chinese Medical Association,and excellent results were obtained in 13 cases and good results in 2 cases.Conclusion The neurovascular staghorn flap is a simple and reliable method to repair fingertip defect.The flap has a good fit with the wound without wasting skin.The appearance and function of the finger are satisfactory after operation.