拇指背侧皮神经营养皮瓣在拇指指端缺损中的应用

Clinical application of dorsal cutaneous neurocutaneous vascular flap of thumb in the treatment of thumb tip defect

目的探讨拇指背侧皮神经营养皮瓣在拇指指端缺损中的临床应用与疗效。方法回顾性分析2014年1月-2021年1月收治的21例拇指指端缺损患者的临床资料,均采用拇指背侧皮神经营养皮瓣修复。结果术后对21例患者进行3~16个月的随访,指端皮瓣全部成活,切口均一期愈合,无感染等并发症出现,术后2例皮瓣远端血运差,最后出现痂下愈合。末次随访时皮瓣两点辨别觉为5~9 mm,拇指长度恢复,缺损处饱满,指甲生长良好,拇指指间关节、掌指关节活动度、对掌功能恢复正常,拇指外形满意。结论拇指背侧皮神经营养皮瓣血供良好、外形美观、耐磨,具有手术操作简单、不损伤主要血管神经、术后恢复时间快、并发症少、皮瓣感觉恢复良好等优点,术后拇指功能与外形恢复良好,患者对治疗效果满意,值得临床推广应用。

Objective To investigate the clinical application and effect of dorsal neurocutaneous vascular flap of thumb in the treatment of thumb tip defect.Methods The clinical data of 21 patients with thumb tip defect treated from January 2014 to January 2021 were retrospectively analyzed.The dorsal neurocutaneous vascular flap of the thumb was used to repair the thumb tip defect.Results Twenty-one patients were followed up for 3 to 16 months.All the fingertip flaps survived,the incision healed in the first stage,and there were no complications such as infection.The distal blood supply of the flap was poor in 2 cases,and finally there was healing under the scab.At the last follow-up,the two-point discrimination range of the flap was 5-9mm,the length of the thumb was restored,the defect was full,the nails grew well,the activity of the interphalangeal joint and metacarpophalangeal joint of the thumb and the function of the opposite palm were restored to normal,and the shape of the thumb was satisfactory.Conclusion The dorsal cutaneous neurocutaneous flap of the thumb has good blood supply,beautiful appearance and wear resistance.It has the advantages of simple operation,no damage to the main blood vessels and nerves,fast postoperative recovery time,few complications and good skin flap sensation recovery.The function and appearance of the patient's thumb recover well after operation.The patient is satisfied with the treatment effect and is worthy of clinical application.