带指神经血管蒂的V-Y岛状推进皮瓣治疗指端皮肤缺损

Treatment of fingertip skin defect with neurovessel pedicled V - Y advanced island flap

目的 介绍应用带双侧或单侧指神经血管蒂的V-Y岛状推进皮瓣修复指端皮肤缺损的疗效。方法 对86例102指指端皮肤缺损患者,设计并采用带双侧或单侧指神经血管蒂的V-Y岛状推进皮瓣修复创面。对指端偏背侧、横截面及缺损长度<1.2 cm的偏掌侧皮肤缺损,用双蒂岛状皮瓣修复;对缺损长度在1.2～2 cm的偏掌侧皮肤缺损,用单蒂岛状皮瓣修复。结果 皮瓣全部成活。20指失访,82指术后平均随访13个月。皮瓣覆盖质量满直,指腹二点分辨觉均在正常范围内,但有2指产生残端神经痛。77指冷天皮瓣能耐寒冷皮温正常,5例5指因皮瓣耐寒性差而影响工作。指间关节活动范围基本正常。结论 该皮瓣较传统的V-Y皮瓣具有手术简单、术后外形好、感觉正常、关节活动不受影响等优点;是修复指端皮肤缺损的有效方法之一。

Objective To introduce the treatment outcome of the fingertip skin defect using V - Y advanced island flap pedicled with both sides or single side of digital neurovessel. Methods Eight-six cases (102 fingers) with skin defect of fingertip were repaired with this kind of flap. For the fingertip skin defect at the dorsal or transverse side or at the palmar side with a defect within 1.2 cm in lengrh, the double pedicle island flap was carried out. For the palmar skin defect with a length between 1.2 - 2 cm, the single pedicle island flap was done. Results All the flaps survived, with 20 cases in loss. The mean follow-up for 82 fingers was 13 months. The coverage was satisfactory with a normal range of 2 point discrimination. There was stump pain in 2 cases. Seventy-seven fingers can endure cold temperature, but 5 fingers (5 cases) can not return to the original work due to the poor cold-resistance. Near normal interphalangeal joint was obtained in the range of motion. Conclusion The neurovascular pedicled V - Y advanced island flap has advantage of simple dissection, satisfactory appearance, normal sensation and normal range of motion of the joint. It is an effective procedure in coverage of fingertip skin defect.