重建静脉回流通道在手指背穿支筋膜蒂岛状皮瓣术中的应用

Application of reconstruction of venous reflux channel in the finger dorsal perforator fascial pedicle island flap

目的探讨重建静脉回流通道在手指背穿支筋膜蒂岛状皮瓣转位修复指部缺损中的应用效果。方法将50例行手指背穿支筋膜蒂岛状皮瓣转位修复的指部缺损患者按是否重建静脉回流通道分为观察组(重建静脉回流通道,25例,25指)和对照组(未重建静脉回流通道,25例,25指)。比较两组手术情况、术后并发症发生情况。采用中华医学会手外科学会上肢部分功能评定试用标准评价疗效。结果患者均获得随访,时间12~24(16.40±3.25)个月。手术时间观察组长于对照组(P<0.01);住院时间、住院费用观察组短(少)于对照组(P<0.05)。两组术后均未发生皮瓣感染及坏死等并发症,皮瓣均成活;水疱发生率观察组低于对照组(P<0.05)。疗效评价:术后1、12个月外形优良率观察组均高于对照组(P<0.05);术后1个月患指总主动活动度优良率观察组高于对照组(P<0.01)。结论重建静脉回流通道行手指背穿支筋膜蒂岛状皮瓣转位修复治疗指部缺损,不仅能缩短住院时间、降低住院费用,而且能获得较满意的患指外形及早期总主动活动度。

Objective To investigate the application effect of the reconstruction of venous reflux channel in the transposition of the dorsal perforator fascial pedicle island flap of the finger for repairing finger defects.Methods Fifty patients with finger defects who underwent finger dorsal perforator fascial pedicle island flap transposition repair were divided into observation group(25 cases,25 fingers)and control group(25 cases,25 fingers)based on whether the venous reflux channel was reconstructed or not.The surgical situation and postoperative complications between the two groups were compared.The efficacy was evaluated by using the trial criteria for evaluating the upper limb function of the Society of Hand Surgery of the Chinese Medical Association.Results All patients were followed up for 12~24(16.40±3.25)months.The observation group was longer than the control group in surgical time(P<0.01);the hospitalization time and hospitalization cost in the observation group were shorter(less)than those in the control group(P<0.05).Both groups did not experience skin flap infection or necrosis,and both groups of flaps survived.The incidence rate of blisters in the observation group was lower than that in the control group(P<0.05).Efficacy evaluation:At 1,12 months after surgery,the excellent-good rate of appearance in the observation group was higher than that in the control group(P<0.05);at 1 month after surgery,the excellent-good rate of total active movement of the affected fingers in the observation group was higher than that in the control group(P<0.01).Conclusions The application of reconstruction of venous reflux channel in the transposition of finger dorsal perforator fascial pedicle island flap for repairing finger defects not only shorten hospitalization time and reduce hospitalization costs,but also achieve satisfactory appearance and early total active movement of the affected finger.