五种皮瓣修复拇指软组织缺损的疗效分析  

Coverage of the thumb soft tissue defect by five kinds of flaps

作　　者：李文庆 王利 宫云霞 王文胜 朱小弟 杨涛 陈传煌 邵明 欧迪军 

机构地区：[1]深圳南山区人民医院手显微外科,518052

出　　处：《中华骨科杂志》2004年第8期474-477,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨五种微型皮瓣修复拇指软组织缺损的疗效及其适应证。方法1998年1月～2003年3月,对52例拇指软组织缺损应用甲皮瓣5例、拇指尺背侧动脉逆行岛状皮瓣15例、大鱼际皮瓣10例、指动脉侧方岛状皮瓣8例、示指背侧岛状皮瓣14例进行修复。缺损部位:拇指脱套伤5例,拇指指腹缺损12例,拇指近节掌侧缺损6例,拇指全掌侧缺损5例,拇指背缺损7例,拇指尺侧缘缺损6例,拇指桡侧缘缺损7例,拇指指端缺损4例。男40例,女12例;年龄17～35岁,平均25岁;左拇指23例,右拇指29例。皮瓣面积最大5.0cm×2.5cm,最小2.0cm×1.5cm。结果皮瓣全部成活,术后随访6～36个月,平均20个月。皮瓣血运、质地良好,外形、功能满意。自带神经皮瓣及吻合神经皮瓣共46例的平均两点分辨觉:甲皮瓣为5.8mm,拇指尺背侧动脉逆行岛状皮瓣为8.5mm,大鱼际皮瓣为7.0mm,指动脉侧方岛状皮瓣为6.2mm,示指背侧岛状皮瓣为8.8mm;6例未吻合神经的皮瓣拇指仅恢复触痛觉,两点分辨觉恢复较差。结论五种皮瓣修复拇指软组织缺损安全可靠,其中甲皮瓣和指动脉侧方岛状皮瓣感觉功能恢复最佳,拇指尺背侧动脉逆行岛状皮瓣和大鱼际皮瓣操作容易,损伤最小。应根据拇指的缺损部位,选择不同修复皮瓣。Objective To explore the curative effect and indication in coverage of the thumb soft tissue defect by five kinds of minute flaps. Methods From January 1998 to March 2003, 52 cases with skin and soft tissue defect of the thumb were treated by five different kinds of flaps: 5 underwent the wrapping flap with nail from the big toe, 15 with the reversible thumb dorso-ulnar artery island flap, 10 with the thenar flap, 8 with the lateral digital island flap, 14 with the index finger dorsal island flap. There were 40 males and 12 females, aged from 17 to 35 years (average, 25 years). The maximum area of the repair flap was 5.0 cm×2.5 cm, and the minimum area was 2.0 cm×1.5 cm. Results All flaps survived. After 6 to 36 months postoperative follow-up, with an average of 20 months. The blood supply and texture of the flaps were excellent, their outer aspect and function were satisfactory. Among 46 cases of flaps with their proper or connecting nerves, the average distance of the two-point discrimination was 5.8 mm in the wrapping flap with nail from the big toe, 8.5 mm in the reversible thumb dorso-ulnar artery island flap, 7.0 mm in the thenar flap, 6.2 mm in the lateral digital island flap, 8.8 mm in the index finger dorsal island flap. Of the 6 cases that the nerves were not connected, the healed flaps had only the pain and touch sensation, the two-point discrimination was poorly recovered. Conclusion The five kinds of flaps are safe and reliable for repairing thumb soft tissue defect, among which the wrapping flap with nail from the big toe and the lateral digital island flap have the advantage of the best sensation recovery, the reversible thumb dorso-ulnar artery island flap and the thenar flap are easy to perform with minimum damage. Better curative effect can be obtained by choosing different flaps according to the site of tissue defect.

关 键 词：拇指软组织缺损 皮瓣修复 缺损 指动脉 逆行岛状皮瓣 示指背侧岛状皮瓣 吻合神经 种皮 成活 部位 

分 类 号：R658.2[医药卫生—外科学]