生物膜密闭包扎治疗Allen Ⅲ型指端缺损的长期随访

Occlusive dressings with biofilms for the treatment of AllenⅢfingertip defects:a long-term follow-up study

目的通过对应用生物膜密闭包扎治疗Allen Ⅲ型指端缺损患者的长期随访,评价其远期疗效。方法回顾性分析2012年8月至2016年12月我们应用生物膜密闭包扎治疗Allen Ⅲ型指端缺损33例患者的临床资料,按指端缺损形状分水平缺损组(A组)17例和斜形缺损组(B组)16例。A、B两组均有15例获得5年以上的随访,且资料完整,末次随访评价指标:再生皮肤两点分辨觉及指纹恢复程度、B超观察指端软组织厚度、勾甲畸形程度、远指间关节活动度、患者满意度。比较两组患者创面完全上皮化时间、恢复工作时间,以及末次随访评价指标。结果随访时间:A组(67.4±6.9)个月,B组(68.3±7.4)个月。创面完全上皮化时间:A组(29.6±4.1)d,B组(31.2±3.8)d。恢复工作时间:A组(26.0±4.3)d,B组(26.9±3.5)d。两组患者末次随访时两点分辨觉:A组(7.1±0.6)mm,B组(7.8±0.6)mm。两组均残留轻度瘢痕,能够恢复部分指纹,B超观察指端软组织厚度B组较A组略差,B组勾甲畸形较为明显,远指间关节活动度均恢复至正常范围,两组患者均满意治疗效果。结论生物膜密闭包扎治疗AllenⅢ型指端缺损远期随访疗效满意,可很大程度恢复指端外观和功能。该技术可以作为治疗部分AllenⅢ型指端缺损的较好选择,尤其适用于水平缺损。

Objective To evaluate the long-term clinical efficacy of occlusive dressings with biofilms in the treatment of AllenⅢfingertip defects through long-term follow-up.Methods A retrospective analysis was conducted on the clinical data of 33 patients with AllenⅢfingertip defects treated with occlusive dressings with biofilms from August 2012 to December 2016.According to the shape of the fingertip defect,there were 17 cases in the horizontal defect group(group A)and 16 cases in the oblique defect group(group B).Both groups of A and B had 15 patients who received more than 5 years of follow-up,and the data was complete.The evaluation indicators for the last follow-up were the two-point discrimination of regenerated skin,the degree of fingerprint recovery,the thickness of soft tissue at the fingertips observed by ultrasound,the degree of nail deformity,the range of motion of the distal interphalangeal joint,and patient satisfaction.The time to complete epithelialization of the wound,the time to resume work,and the final follow-up evaluation indicators between two groups of patients were compared.Results The follow-up time was(67.4±6.9)months for group A and(68.3±7.4)months for group B.The time to complete epithelialization of the wound was(29.6±4.1)days for group A and(31.2±3.8)days for group B.The time to resume work was(26.0±4.3)days for group A and(26.9±3.5)days for group B.At the last follow-up,the two-point discrimination was(7.1±0.6)mm for group A and(7.8±0.6)mm for group B.Both groups had residual mild scars and were able to restore some fingerprints.According to ultrasound observation,the thickness of soft tissue at the fingertips in group B was slightly worse than that in group A.The patients in group B had more obvious nail deformity.The range of motion of the distal interphalangeal joint of both groups returned to normal,and all the patients were satisfied with the treatment effect.Conclusion The long-term follow-up efficacy of occlusive dressings with biofilms for the treatment for AllenⅢfingertip defects is satisfactory,and it can greatly restore the appearance and function of the fingertip.This technique can be a good choice for the treatment of partial AllenⅢfingertip defects,especially suitable for horizontal defects.