掌指关节处带指动脉神经的V-Y成形皮瓣修复中远节指腹缺损

A V-Y shaped flap with digital artery nerve at metacarpophalangeal joint was used to repair the defect of middle and distal phalanx

目的:探讨一种中、远节指腹部软组织缺损创面覆盖、外形重建及感觉、血管修复的手术方法。方法:自2016年1月至2020年1月,用掌指关节处带指动脉、神经的V-Y成形皮瓣修复治疗14例拇指远节、2-4指中、远节指腹软组织缺损患者。其中男9例,女5例;年龄22~69岁;病程0.5~2 d。指腹缺损面积约(2.0~2.5)cm×(1.5~2.0)cm。术中自掌指关节以近至缺损处游离皮瓣,掌指关节处切口设计成“V”形,双侧血管、神经游离至指总动脉、指总神经分叉处。屈曲掌指、近指、远指关节,远节指腹缺损皮瓣远端塑形后缝合覆盖,中节指腹缺损皮瓣前移后吻合指动脉、指神经。术后3周患指功能锻炼。观察术后患者手指活动度、指腹感觉、外形等指标。依据中华医学会手外科学会上肢部分功能评定试用标准评定手术效果。结果:14例皮瓣全部成活,10例远节指腹缺损者术后指腹即恢复感觉,4例中节指腹缺损者术后2~3个月感觉逐步恢复。13例患者获得随访,时间6~20个月。指腹两点分辨觉4~6 mm,感觉功能评分达S3级以上,指腹形状逼真,皮色、皮温正常,耐磨性、耐寒性好,指关节功能基本正常。依据中华医学会手外科学会上肢部分功能评定试用标准评定手术效果,功能总评分优13例,良1例。结论:掌指关节处带指动脉、神经的V-Y成形皮瓣修复中节或远节指腹缺损,术式简单,风险低,可延长指动脉皮瓣修复范围,恢复指腹外形、血供和感觉,患者满意度高。

Objective To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits.Methods From January 2016 to January 2020,a total of 14 patients,9 males and 5 females,ages ranging from 22 to 69 years old,and with volar soft tissue defects in the middle and distal digits 2 to 4,underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint.The defect area was(2.0~2.5)cm×(1.5~2.0)cm.The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint.Flap design,dissection of blood vessels and nerves,and anastomosis with the digital artery and nerve were performed according to a standardized protocol.,Functional exercise of affected finger was initiated 3 weeks postoperatively.Subsequent assessments were conducted to evaluate finger pulp sensation,shape and other relevant parameters.According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association,the surgical outcomes were evaluated.Results All 14 cases demonstrated successful tissue transplantation,,with immediate recovery of sensation observed in 10 cases with distal finger pulp defects.Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively.Thirteen patients were followed up for a mean duration of(8.8±4.49)months,during which satisfactory outcomes were observed.The average two-point resolution of the finger pulp was 4-6mm,and sensory function evaluation yielded a score of S3 or above.Patients exhibited realistic finger shape,normal skin color and temperature,good wear resistance,and cold resistance.Furthermore,finger joint function was essentially normal.Conclusion The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger.This technique is characterized by its simplicity,low risk,and favorable outcomes,including restored finger shape,blood supply and sensation.Moreover,high patient satisfaction was achieved.