第1掌骨背侧带神经动脉化静脉皮瓣治疗拇指和手指指腹缺损

Innervated arterialised venous flap of the first dorsal metacarpal in reconstruction of thumb and finger pulp defect

目的探讨第1掌骨背侧带神经动脉化静脉皮瓣在拇、手指指腹缺损中的应用及临床疗效。方法2021年12月-2022年8月,四川现代医院手外科收治17例拇、手指指腹缺损患者,均为急诊。拇指3指,示指4指,中指6指,环指1指,小指3指。急诊清创后,取拇指第1掌骨背侧带桡神经浅支动脉化静脉皮瓣修复;供区直接拉拢缝合。术后通过门诊、电话、微信方式随访,评估手指及皮瓣成活情况及功能恢复情况。结果术后有7例皮瓣发生水疱,经换药后逐渐消退、结痂愈合。其余10例皮瓣顺利成活,所有皮瓣均未发生血管危象。17例17指获得3~15个月随访,平均8个月。拇、手指指腹外观好,手指感觉按照英国医学研究会(BMRC)感觉功能评定标准评定,感觉恢复至S_(1)~S_(3)^(+)级;根据中华医学会手外科学会上肢部分功能评定试用标准,手指总主动活动度(TAM)17例均为优。结论第1掌骨背侧带神经动脉化静脉皮瓣修复指腹缺损,功能、外形恢复好,皮瓣切取简单,感觉恢复满意。

Objective To explore the application and clinical efficacy of an innervated arterialised venous flap of the first dorsal metacarpal in reconstruction of thumb and finger pulp defects.Methods From December 2021 to August 2022,17 patients received surgery for reconstruction of thumb and finger pulp defects in the Department of Hand Surgery of Sichuan Modern Hospital.All were carried out in emergency surgery.The affected digits included:3 thumbs,4 index fingers,6 middle fingers,1 ring finger and 3 little fingers.After emergency debridement,a flap of the first dorsal metacarpal carrying superficial radial nerve and arterialised vein was taken for reconstruction of the defect.Donor site of the flap was directly closed with sutures.The survival and functional recovery of the digits and flaps were evaluated through postoperative follow-ups via outpatient visit and telephone and WeChat interviews.Results Seven flaps developed blisters after surgery,which gradually subsided and healed after dressing change.The rest of 10 flaps survived smoothly,without any vascular compromise.All of the 17 patients(17 digits)had postoperative follow-up for 3-15 months,with 8 months in average.Appearance of thumb and finger pulps were good,with sensation restored to S_(1)-S_(3)^(+),according to the sensory function evaluation criteria of the British Medical Research Council(BMRC).According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,all 17 patientswere in excellent of total active movement(TAM).Conclusion Innervated arterialised venous flap of the first dorsal metacarpal is reliable in reconstruction of the defects of digit pulps with good function and appearance.The flap is easy to take and with a satisfactory recovery of sensation.