桡背侧指动脉穿支螺旋桨皮瓣与常规桡背侧皮瓣修复拇指指端缺损的效果比较

Comparison of effects of radial dorsal digital artery perforator pedicled propeller flap and conventional dorsal radial flap in repair of thumb tip defects

目的:比较桡背侧指动脉穿支螺旋桨皮瓣与常规桡背侧皮瓣修复拇指指端缺损的效果。方法:选取2020年7月至2022年6月该院收治的78例拇指指端缺损患者进行前瞻性研究,按随机数字表法将其分成对照组和观察组各39例。对照组接受常规桡背侧皮瓣修复,观察组接受桡背侧指动脉穿支螺旋桨皮瓣修复。比较两组手术相关指标[两点分辨觉(TPD)、创面愈合时间、手术时间]水平,手术前后血清生长因子[碱性成纤维细胞生长因子(bFGF)、转化生长因子β1(TGF-β1)、人表皮生长因子(EGF)]水平,术后6个月感觉功能恢复率、并发症发生率,以及美观效果满意度。结果:观察组创面愈合时间短于对照组,TPD值小于对照组,差异均有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05);术后6个月,观察组触、痛、热、冷等感觉功能恢复率均高于对照组,差异有统计学意义(P<0.05);术后3、6个月,两组血清bFGF、EGF、TGF-β1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5.13%(2/39),低于对照组的23.08%(9/39),差异有统计学意义(P<0.05);观察组修复美观效果满意度为97.44%(38/39),高于对照组的76.92%(30/39),差异有统计学意义(P<0.05)。结论:桡背侧指动脉穿支螺旋桨皮瓣修复拇指指端缺损患者可改善手指功能,促进创面愈合,减少并发症,提高美观效果满意度,效果优于常规桡背侧皮瓣修复。

Objective:To compare effects of radial dorsal digital artery perforator pedicled propeller flap and conventional dorsal radial flap in repair of thumb defects.Methods:A prospective study was conducted on 78 patients with finger tip defects admitted to this hospital from July 2020 to June 2022.They were divided into control group and observation group according to the random number table method,39 cases in each group.The control group received conventional dorsal radial flap repair,while the observation group received thumb radial dorsal digital artery perforator pedicled propeller flap.The operation-related indicators levels[two-point discrimination(TPD),wound healing time,operation time],the serum indicator levels[basic fibroblast growth factor(bFGF),transforming growth factor-β1(TGF-β1),human epidermal growth factor(EGF)]before and after the surgery,the recovery rate of tactile,pain,temperature and other sensory functions,the incidence of complications,and the satisfaction of aesthetic effects were compared between the two groups.Results:The TPD and the wound healing time of the observation group were shorter than those of the control group,and the differences were statistically significant(P<0.05).6 months after the surgery,the recovery rates of sensory function such as touch,pain,heat and cold in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).3 and 6 months after the surgery,the levels of serum bFGF,EGF and TGF-β1 in the two groups were higher than those before the surgery,those in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 5.13%(2/39),which was lower than 23.08%(9/39)in the control group,and the difference was statistically significant(P<0.05).Further,the satisfaction rate of repair aesthetic effect in the observation group was 97.44%(38/39),which was higher than 76.92%(30/39)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Thumb radial dorsal digital artery perforator pedicled propeller flap for repairing the finger tip defects can shorten the TPD,promote the sensory function recovery and the wound healing,reduce the complications,and improve the aesthetic effect satisfaction.Moreover,it is superior to conventional dorsal radial flap repair.