邻指指固有动脉背侧穿支皮瓣治疗手指高压注射伤的临床疗效

Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatmentof high-pressure injection injuries of the finger

目的探讨采用邻指指固有动脉背侧穿支皮瓣治疗高压注射伤导致的手指皮肤软组织缺损疗效。方法2011年7月—2020年6月,采用邻指指固有动脉背侧穿支皮瓣修复14例高压注射伤导致的手指软组织缺损创面。患者均为男性;年龄22~56岁,平均36岁。示指8例、中指4例、环指2例。致伤原因:乳胶漆注射伤8例,油漆注射伤4例,水泥注射伤2例。受伤至急诊清创时间为2~8 h,平均4.5 h。清创后软组织缺损范围4.0 cm×1.2 cm~6.0 cm×2.0 cm;皮瓣切取范围4.5 cm×1.5 cm~6.5 cm×2.5 cm,皮瓣供区采用前臂近端全厚皮片修复。术后3周断蒂后开始手指功能锻炼。结果术后14例皮瓣及供区植皮均顺利成活,创面均Ⅰ期愈合。术后12例获随访,随访时间16~38个月,平均22.6个月。手指指腹饱满、耐磨性好,皮瓣颜色及质地与周围组织相似;皮瓣两点辨别觉10~12 mm,平均11.5 mm;患指末端均存在不同程度的冷不耐受及失神经性指端萎缩。末次随访时按中华医学会手外科学会上肢部分功能评定试用标准评价手指功能,获优3例、良8例、差1例。结论邻指指固有动脉背侧穿支皮瓣可以有效修复高压注射伤导致的手指皮肤软组织缺损,手术操作简便,手指外观及功能恢复良好。

Objective To investigate the effectiveness of dorsal perforator flap of cross-finger proper digitalartery in the treatment of finger soft tissue defect caused by high-pressure injection injury.Methods Between July 2011and June 2020,14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsalperforator flap of cross-finger proper digital artery.All patients were male,with a mean age of 36 years(range,22-56years).The defects were located on the index finger in 8 cases,middle finger in 4 cases,and ring finger in 2 cases.Thecauses of injury include 8 cases of emulsion paint injection,4 cases of oil paint injection,and 2 cases of cement injection.The time from injury to debridement was 2-8 hours,with a mean time of 4.5 hours.The soft tissue defects sized from4.0 cm×1.2 cm to 6.0 cm×2.0 cm.The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm.The donor site of the flap was repaired with skin graft.The pedicle was cut off at 3 weeks after operation,and followed by functional exercise.Results Allflaps and skin grafts at donor sites survived,and the wounds healed by first intention.Twelve patients were followed-up16-38 months(mean,22.6 months).The texture and appearance of all flaps were satisfactory.The color and texture of theflaps were similar to those of the surrounding tissues.The two-point discrimination of the flap was 10-12 mm,with amean of 11.5 mm.There were different degrees of cold intolerance at the end of the affected fingers.At last follow-up,thefinger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand SurgeryBranch of Chinese Medical Association,3 cases were excellent,8 cases were good,and 1 case was poor.Conclusion Thedorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury.The operation was simple,and the appearance and function of the finger recover well.