远端蒂指背皮神经营养血管皮瓣修复指腹创伤缺损  

Distally based dorsal digital neurocutaneous flap for finger-pulp reconstruction

作　　者：张世民[1] 王保山 曹艳 高树林 李玉坤 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科,上海市200065 [2]解放军第八十五医院手外科

出　　处：《中华显微外科杂志》2006年第5期331-334,i0002,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(30571896);上海市卫生局科研基金(044102)

摘　　要：目的介绍应用指背皮神经营养血管皮瓣修复指腹创伤缺损的临床经验,并探讨改善静脉回流的方法。方法自2004年3月至2005年10月,共急诊应用远端蒂指背皮神经营养血管皮瓣,修复指腹创面大于2 cm者18例。旋转轴点在近侧指间关节(PIP)平面以近0．5 cm,皮瓣面积2 cm×2 cm～3 cm×4 cm,皮神经筋膜蒂长2～3 cm。均将指背皮神经与指固有神经吻接,并在旋转点远侧1 cm处结扎指背浅静脉。结果术后皮瓣均有不同程度的静脉淤血肿胀,8例皮瓣出现张力水泡。13例随访超过6个月,皮瓣恢复保护性感觉。结论指背皮神经营养血管皮瓣修复指腹创伤缺损,方法简单,成活可靠。在蒂部远侧结扎指背浅静脉干阻断倒灌和在末端旷置敞开,均能改善静脉回流,减轻皮瓣肿胀。Objective To introduce the clinical experience and investigate venous drainage of distally-based dorsal digital neurocutaneous flap for finger-pulp reconstruction. Methods From Mar. 2004 to Oct. 2005,18 patients with traumatic finger-pulp defect （ 〉 2cm） were treated by distally based dorsal homodigital neurocutaneous flaps. The flap measured 2 cm× 2 cm～3 cm× 4 em with the neuro-veno-adipal pediele I em wide and 2 - 3cm long. The pivot points were proximal to the PIP joints. The dorsal digital nerve was neurorrhaphied with the proper digital nerve of the recipient site. The dorsal digital vein was ligated at 1 em distal to the pivot point to prevent venous ingress. No venous anastomosis was performed. Results All the flaps survived but had some degrees of venous congestion and swelling, and 8 flaps developed tension blisters. In 13 flaps with follow-up more than 6 months, protective sensation was restored. Conclusion Dorsal digital neuroeutaneous flap is simple and effective for finger-pulp reconstruction. Ligating the big superficial vein at the distal base to interrupt venous ingress, and allowing the proximal vein open and venous egress, can reduce flap congestion and swelling.

关 键 词：指腹 指背皮神经 皮神经营养血管皮瓣 移植 

分 类 号：R658[医药卫生—外科学]