改良同指逆行指动脉岛状皮瓣修复指端缺损  

MODIFIED REVERSE HOMODIGITAL ARTERY ISLAND FLAP FOR REPAIR OF FINGERTIP DEFECT

作　　者：郑有卯[1] 张法云[1] 吴立志[1] 宋树清[1] 郑卜真[1] 顾仕林[1] 

机构地区：[1]台州医院路桥院区手足外科,浙江台州318500

出　　处：《中国修复重建外科杂志》2009年第7期811-813,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨改良同指逆行指动脉岛状皮瓣修复指端缺损的手术方法及疗效。方法2000年3月-2006年9月,收治18例24指指端缺损。男12例,女6例;年龄18～53岁,平均29岁。致伤原因:冲压伤12例,撕脱伤3例,绞伤2例,切割伤1例。其中示指3指,中指4指,环指17指。缺损部位:指端末节缺损10指,指腹缺损14指。软组织缺损范围1.9cm×1.7cm～2.4cm×1.9cm。受伤至手术时间为2～8h,平均4h。术中采用大小为2.0cm×1.5cm～2.5cm×2.0cm改良同指逆行指动脉岛状皮瓣修复缺损。供区采用遗弃皮回植或足底内侧区全厚皮片植皮修复。结果术后皮瓣及植皮全部成活,供受区切口均Ⅰ期愈合。16例22指获随访,随访时间1～5年,平均3.2年。皮瓣外观与健侧相似,无明显色素沉着及瘢痕挛缩。皮瓣两点辨别觉为4.5～6.3mm。参照关节总主动活动度/被动活动度评定标准,获优20指,良2指。供区指周径与健侧相比相差2.0～3.5mm,供区两点辨别觉为7.8～10.5mm。结论改良同指逆行指动脉皮瓣修复指端缺损可获得满意的外观和优良的功能,并且供区损伤小。Objective To investigate the operative method and clinical efficacy of repairing fingertip defect with modified reverse homodigital artery island flap. Methods From March 2000 to September 2006, 18 cases （24 fingers） of fingertip defect were treated, including 12 males and 6 females aged 18-53 years （mean 29 years）. Defect was caused by crush injuries in 12 cases, by avulsion injury in 3 cases, by twist injury in 2 cases and by incised injury in 1 case. The time from injury to operation was 2-8 hours （mean 4 hours）. The location were index fingers （3 fingers）, middle fingers （4 fingers） and ring fingers （17 fingers）. The defects of soft tissue were 1.9 cm × 1.7 cm to 2.4 cm × 1.9 cm in size, the reverse homodigital artery island flaps were from 2.0 cm × 1.5 cm to 2.5 cm × 2.0 cm in size. The donor site was repaired with dumped skin grafting（3 cases） and with skin grafting from medial area of planta pedis （15 cases）. Results Skin flaps and skin grafting of all the 24 fingers survived after operation. All incisions and donor sites healed by first intention. Sixteen patients （22 fingers） were followed up for 1-5 years （mean 3.2 years）.The appearance and function of the flaps were all satisfactory. Two-point discriminations of flaps ranged from 4.5 mm to 6.3 mm. According to the total active movement/total passive movement assessment criteria, the results were excellent in 20 fingers and good in 2 fingers; and the excellent and good rate was 100%. The circumference of donor site was 2.0-3.5 mm shorter than that of normal side. The two-point discriminations of donor site was 7.8-10.5 mm. Conclusion Repairing defect of fingertip with modified reverse homodigital artery island flap can provide good texture and contour matching the recipient area, good function and little trauma at donor site.

关 键 词：逆行指动脉皮瓣 改良 指端缺损 修复 

分 类 号：R658.2[医药卫生—外科学]