拇指桡侧逆行岛状筋膜皮瓣修复拇指指腹缺损

Repair of thumb pulp defects with a reverse island fascial flap pedicled by thumb radial vessels

目的 :介绍拇指桡侧血管逆行岛状筋膜皮瓣修复拇指指腹缺损的手术方法及临床效果。方法 :自 1999年 5月～ 2 0 0 2年 2月 ,对 11例应用拇指桡侧血管逆行岛状筋膜皮瓣修复拇指指腹缺损。在第一掌骨桡背侧设计皮瓣 ,自甲根部桡侧缘至第一掌骨同侧背侧缘的连线为轴心线 ,轴点位于指间关节近侧 1cm以近的轴心线上。切取的皮瓣内含有桡神经浅支 ,转移后与创面指固有神经断端吻合。结果 :19例皮瓣全部成活 ,随访 7～ 2 8个月 ,质地柔软、耐磨 ,指腹两点辨别觉为 6 .6～ 8.1m m。供区无并发症 ,掌指关节活动正常。结论 :该皮瓣具有不损伤主要动脉、神经 ,操作简便 ,质地良好 ,血供可靠等优点 ,重建的指腹感觉恢复满意 。

Objective:To introduce a reverse island fascial flap pedicled by thumb radial vessels for the repair of thumb pulp defects.Methods:From may 1999 to January 2002,nineteen patients with thumb pulp defects were treated with thumb pulp defects.Based on the features of blood supply of the radial dorsal skin of thumb,the flap was designed at the dorsum of first metacarpal,with axial line from the radial base of the thumb nail to the radial dorsal side of first metacarpal,and axial point within 1 cm proximal to the interphalangeal joint.The superficial branch of radial nerve in the flap was sutured to the end of the proper digital nerve of injured site.Results:All flaps survived completely in 19 cases.They were followed up from 7 to 28 months,with an average of 13 months.the pulp of thumb after reconstruction had good appearance and senstaion static 2 point descrimination(2-pd) of 4.0 mm to 7.5 mm.Conclusion:The operation doesn′t damage the proper digital artery and nerve of thumb.The flap is a reliable flap with easy dissection and good fexture in the repair of finger pulp defects.The sensation of the reconstructed pulp can be satisfactorily recovered.