指动脉背侧支带蒂皮瓣桥接修复手指局部软组织缺损对患指血流动力学及瘢痕的影响

The effect of dorsal branch flap of digital artery for repairing local soft tissue defect of fingers on hemodynamics and cicatrix of affected finger

目的探讨指动脉背侧支带蒂皮瓣桥接修复手指局部软组织缺损对患指血流动力学及瘢痕的影响。方法回顾性选择2017年6月至2020年6月在恩施土家族苗族自治州中心医院接受治疗的100例手指局部软组织缺损患者为研究对象,其中46例接受指动脉背侧支带蒂皮瓣桥接修复手术(指动脉组),54例接受桡动脉穿支腕横纹皮瓣桥接修复手术(桡动脉组),比较两组手术优良率、手术相关指标及术后并发症发生率;比较两组手术前后患指血流动力学指标及术后皮瓣修复评分、疼痛视觉模拟量表(VAS)评分、温哥华瘢痕量表(VSS)评分。结果两组手术优良率比较差异无统计学意义(P>0.05)。指动脉组两点辨别觉小于桡动脉组[(5.09±1.27)mm比(6.71±1.46)mm],愈合时间及住院时间短于桡动脉组[(17.69±2.42)d比(19.83±2.11)d、(10.18±1.46)d比(11.97±1.52)d],差异有统计学意义(P<0.05);两组手术时间、一期愈合率及触觉、冷觉、热觉及痛觉恢复率比较差异无统计学意义(P>0.05)。指动脉组术后3 d血流速度、血流灌注量相对值高于桡动脉组[(36.89±2.10)cm/s比(35.02±2.07)cm/s、(65.28±4.61)%比(62.34±4.58)%],差异有统计学意义(P<0.05)。指动脉组术后1周皮瓣修复评分高于桡动脉组[(12.34±1.61)分比(11.01±1.58)分],VAS、VSS评分均低于桡动脉组[(2.68±0.34)分比(2.89±0.38)分、(4.05±0.65)分比(4.52±0.62)分],差异有统计学意义(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论指动脉背侧支带蒂皮瓣桥接修复手指局部软组织缺损有助于术后患指血流动力学恢复,并能缓解术后疼痛程度,促进术后恢复,减轻瘢痕严重程度。

Objective To explore the effect of dorsal branch flap of digital artery for repairing local soft tissue defect of fingers on hemodynamics and cicatrix of affected finger.Methods One hundred patients with local soft tissue defect of fingers who were operated in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from June 2017 to June 2020 were selected and 46 patients were treated with bridging repair of dorsal branch flap of digital artery(digital artery group)and 54 patients were treated with superficial branch of radial artery wrist crease flap repairing surgery(radial artery group).The superior rate of surgery,surgical related indexes and the total incidence of postoperative complications were compared between the two groups.The changes of hemodynamics index,postoperative flap repair scores visual analog scale(VAS)scores and Vancouver Scar Scale Score(VSS)scores were compared between the two groups.Results The superior rate of surgery between the two groups had no significant difference(P>0.05).The two-point discrimination in the digital artery group was less than that in the radial artery group:(5.09±1.27)mm vs.(6.71±1.46)mm;and the healing time and hospitalization time in the digital artery group were shorter than those in the radial artery group:(17.69±2.42)d vs.(19.83±2.11)d,(10.18±1.46)d vs.(11.97±1.52)d,there were statistical differences(P<0.05).The operation time,first stage healing rate,tactile,cold,heat and pain recovery rate between the two groups had no significant differences(P>0.05).After operation for 3 d,the blood flow velocity(BFV),relative value of blood perfusion volume(BPR)in the digital artery group were higher than those in the radial artery group:(36.89±2.10)cm/s vs.(35.02±2.07)cm/s,(65.28±4.61)%vs.(62.34±4.58)%,there were statistical differences(P<0.05).After operation for 1 week,the flap repair scores in the digital artery group was higher than that in the radial artery group:(12.34±1.61)scores vs.(11.01±1.58)scores;and the VAS and VSS scores in the digital artery group were lower than those in the radial artery group:(2.68±0.34)scores vs.(2.89±0.38)scores,(4.05±0.65)scores vs.(4.52±0.62)scores,there were statistical differences(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusions Dorsal branch flap of digital artery for repairing local soft tissue defect of fingers can contribute to the hemodynamic recovery of the affected finger,relieve the degree of postoperative pain,promote postoperative recovery,and reduce the severity of cicatrix.