两种带蒂皮瓣转移修复手指掌侧缺损的比较

Comparison of two pedicle flap transfers for repairing palmar tissue defects of fingers

[目的]比较指动脉背侧支皮瓣与掌背动脉返支皮瓣急诊修复手指中末节掌侧软组织缺损的临床效果。[方法]2015年5月—2020年8月,收治第2~5指中末节掌侧软组织缺损急诊入院患者46例。依据医患沟通结果,25例采用指背侧支皮瓣,21例采用掌背返支皮瓣。比较两组围手术期情况及随访结果。[结果]两组患者均顺利完成手术,无严重并发症。指背侧组采用植皮闭合供区,而掌背返支组供区闭合多采用直接缝合,前者显著不及后者(P<0.05)。两组手术时间、术后1周皮瓣成活面积、供区切口愈合等级、拆线时间及住院时间的差异均无统计学意义(P>0.05)。两组所有患者均获随访9~20个月,平均(13.6±2.4)个月。末次随访时,指背侧支组患者皮瓣静态两点辨别觉及外观满意度评分均优于掌背返支组(P<0.05),而两组伤指关节TAM的差异无统计学意义(P>0.05)。[结论]两种皮瓣均可有效修复手指中末节掌侧软组织缺损,相比之下,指动脉背侧支皮瓣感觉更好、外形更美观。

[Objective]To compare the clinical results of the dorsal branch of digital artery flap(DBDA)and dorsal metacarpal artery return branch flap(DMARB)transfer for the emergency repair of the palmar soft tissue defect on the middle and distal segment of the fin⁃ger.[Methods]From May 2015 to August 2020,46 patients received surgical repair of soft tissue defect on the middle and distal segment of the 2 to 5 fingers.According to doctor-patient communication,25 patients received DBDA flap,while the remaining 21 patient had wound repaired with the DMARB flap.The perioperative conditions and follow-up results of the two groups were compared.[Results]All the patients in both groups had operation performed smoothly without serious complications.The donor area was closed by skin grafting in the DBDA group,while mainly by direct suture in the DMARB group,and the former was significantly inferior to the latter(P<0.05).Howev⁃er,there were no significant differences in operation time,flap survival area 1 week after operation,incision healing grade in donor area,su⁃ture removal time and hospital stay between the two groups(P>0.05).All patients in both groups were followed up for 9 to 20 months,with an average of(13.6±2.4)months.At the last follow-up,the DBDA group proved significantly superior to the DMARB group in terms of stat⁃ic two-point recognition and appearance satisfaction scores(P<0.05),despite of the fact that there was no statistical significance in total ac⁃tive motion(TAM)between the two groups(P>0.05).[Conclusion]Both of the two types of flap transfer do effectively repair the soft tissue defects on the palmar side of the middle and distal segments of the finger.By contrast,the DBDA flap achieves better feeling and more cos⁃metic appearance than the DMARB flap.