指动脉背侧穿支蒂拇指背神经营养血管皮瓣修复拇指尺侧缺损创面

Dorsal thumb neurocutaneous vascular flap pedicled with digital arterial dorsal branch for the repair of the soft tissue defect of ulnar thumb

目的探讨应用显微外科技术利用指固有动脉背侧穿支蒂指背神经营养血管皮瓣修复拇指尺侧缺损创面的临床疗效.方法我科自2015年7月至2023年5月采用指固有动脉背侧穿支蒂指背神经营养血管皮瓣修复拇指缺损创面,并应用显微外科技术对其蒂部进行暴露分离及旋转,本组患者29例,男19例,女10例;年龄21~57岁,平均32.6岁.机器绞伤13例,挤压伤10例,电锯伤4例,切割伤2例;左侧9例,右侧20例.皮瓣切取范围为1.0 cm×1.5 cm~1.5 cm×3.0 cm,供区创面直接拉拢缝合.结果术后29例皮瓣全部存活,创面均Ⅰ期愈合,随访11~21个月,平均17.5个月.末次随访皮瓣外形质地满意,手指功能恢复好.患者对术后疗效满意.结论指固有动脉穿支蒂桡神经浅支营养血管皮瓣血管蒂恒定,携带神经可重建拇指感觉,易于切取,应用显微外科技术切取使皮瓣血运更为可靠、供区损伤小,术后恢复快,减少住院时间,修复治疗拇指尺侧缺损创面疗效满意,方便临床推广.

Objective To investigate the clinical efficacy of dorsal thumb neurocutaneous vascular flap pedicled with digital arterial dorsal branch for the repair of the soft tissue defect of ulnar thumb.Methods From July 2015 to May 2023,our department used dorsal thumb neurocutaneous vascular flap pedicled with digital arterial dorsal branch to repair the soft tissue defect of thumb,and applied microsurgical techniques to expose,separate,and rotate the pedicle.There were 29 patients in this group,19 males and 10 females.The age range was 21 to 57 years old,with an average of 32.6 years old.There were 13 cases of machine strangulation injury,10 cases of crushing injury,4 cases of chainsaw injury,and 2 cases of cutting injury.There were 9 cases on the left and 20 cases on the right.The flap was cut from a range of 1.0 cm×1.5 cm to 1.5 cm×3.0 cm,and the donor site wound was directly pulled and sutured.Results All 29 skin flaps survived after surgery,and the wounds achieved primary healing.The postoperative follow-up was 11 to 21 months,with an average of 17.5 months.The last follow-up showed satisfactory appearance and texture of the skin flap,and good recovery of finger function.The patient was satisfied with the postoperative efficacy.Conclusion The nutrient vessel pedicle of the radial nerve superficial branch of the intrinsic artery perforating branch of the finger flap is constant,carrying nerves that can reconstruct the sensation of the thumb,making it easy to cut.The application of microsurgical techniques makes the blood supply of the flap more reliable,the damage to the donor area is small,the postoperative recovery is fast,the hospital stay is reduced,the repair and treatment of the thumb ulnar defect wound is satisfactory,and it is convenient for clinical promotion.