指掌侧固有动脉背侧支皮瓣修复远侧指骨间关节黏液囊肿切除术后软组织缺损

Reconstruction of soft tissue defect after resection of mucous cyst of distal interphalangeal joint with a flap of dorsal branch of proper palmar digital artery

目的探讨利用指掌侧固有动脉背侧支皮瓣转移修复远侧指骨间关节(DIP)黏液囊肿切除后软组织缺损创面的临床效果。方法自2021年9月至2023年9月,滨州医学院附属医院手(显微)外科收治DIP囊肿8例8指,均为女性,年龄55~65岁,平均60岁;囊肿位于拇指1例,示指3例,中指3例,环指1例。采用囊肿扩大切除后,创面大小0.8 cm×0.6 cm~1.7 cm×0.9 cm,于创面边缘以同侧指掌侧固有动脉终末支为蒂,沿创面近端边缘向指背侧设计皮瓣覆盖创面,皮瓣大小1.2 cm×1.0 cm~2.0 cm×1.2 cm,皮瓣供区采用臂内侧全厚皮覆盖。术后采用门诊复诊和电话相结合的方式进行随访,观察皮瓣的成活情况,并参照中华医学会手外科学会上肢部分功能评定试用标准评定功能恢复情况。结果术后8例皮瓣均成活良好,随访时间为4~12个月,平均10个月。末次随访均未见肿物复发,症状消失。所有皮瓣均一期愈合,外形良好,质软,色泽和周围皮肤无明显差异。植皮区一期愈合。DIP活动度0°~70°,TPD恢复至7~8 mm,对日常生活无影响,根据中华医学会手外科学会上肢部分功能评定试用标准,结果为优。结论指掌侧固有动脉背侧支皮瓣在修复DIP黏液囊肿切除后软组织缺损的优势明显,创伤小,操作简单,是一种较为理想的手术方式。

ObjectiveTo explore the clinical effect on reconstruction of the soft tissue defects after resection of mucous cysts of distal interphalangeal joint(DIP)with transfer of the flap of dorsal branch of proper palmar digital artery.MethodsFrom September 2021 to September 2023,8 patients(8 digits)with mucous cysts on DIP were treated in the Department of Hand and Microsurgery,the Affiliated Hospital of Binzhou Medical University.All 8 cases were females,aged 55-65 years old,with an average age of 60 years old.The cyst was located in the thumb in 1 case,in the index finger in 3 cases,in the middle finger in 3 cases,and in the ring finger in 1 case.After extensive resection of the mucous cysts,the size of soft tissue defects was at 0.8 cm×0.6 cm-1.7 cm×0.9 cm.Pedicled with the dorsal branch of proper palmar digital artery,the flaps adjacent to the defects were designed to cover the wounds.The size of the flaps was 1.2 cm×1.0 cm-2.0 cm×1.2 cm.Donor sites of the flap were covered by the full thickness skin grafts of medial upper arm.The postoperative follow-up was conducted by the combination of outpatient revisits and telephone reviews to observe the survival of the flap,and the functional recovery was evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.ResultsAll flaps survived well after surgery.Postoperative follow-up ranged from 4 to 12 months,with a mean of 10 months.At the final follow-up,there was no recurrence of mucous cyst and all symptoms disappeared.All flaps healed well,with good appearance,soft texture and without obvious difference in colour from the surrounding skin.All skin grafts healed in one stage.The range of motion of the affected DIP was 0°-70°,and the TPD was at 7-8 mm,both caused no impact on daily life.The outcomes were excellent according to the evaluation criteria set by the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.ConclusionThe flap pedicled with dorsal branch of proper palmar digital artery has obvious advantages with less damage and simple operation in the treatment of a mucous cyst of DIP.It is an ideal surgical procedure.