应用拇指背侧皮神经营养血管逆行皮瓣修复拇指皮肤软组织缺损  

Reconstruction of thumb soft tissue defects with reverse flaps nutriented with dorsal nerve

作　　者：沈尊理[1] 黄一雄[1] 贾万新[1] 黄燮青[1] 蔡嫫娴 张兆锋[1] 沈华[1] 

机构地区：[1]上海交通大学附属第一人民医院整形外科,上海200080

出　　处：《中国美容整形外科杂志》2009年第12期717-720,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨拇指桡、尺背侧神经营养血管皮瓣修复拇指创面的适应证、临床疗效和并发症的防治措施。方法对24例外伤引起的拇指皮肤软组织缺损患者，创面大小为1cm×2cm-3cm×5cm，采用逆行拇指背侧神经营养血管皮瓣转移修复。其中8例修复拇指指腹缺损患者中，将皮瓣内皮神经与拇指指神经吻合。结果5例术后出现皮瓣远端静脉回流障碍，经采取拆除部分缝线，应用肝素生理盐水擦拭皮瓣边缘等应对措施后均未发生皮瓣坏死。平均随访13个月，所有皮瓣均存活，并恢复保护性感觉，其中吻合神经的皮瓣两点辨别觉为8～10mm。结论拇指背侧神经营养血管逆行皮瓣是修复拇指掌指关节以远任何部位创面的良好选择，吻合皮瓣内的皮神经能较好地恢复皮瓣的感觉。Objective To investigate the indications, clinical results, complications and their managements of reverse flaps nutriented with dorsoradial or dorsoulnar nerve for repairing soft tissue defects in the thumb. Methods Twenty-four cases of soft tissue defects in the thumb were included in this study, the dimension of defects ranged from 1 cm× 2 cm - 3 cm × 5 cm. All cases were repaired by reverse flaps nutriented with dorsal nerve. Among them, the cutaneous nerve in the flap was anastomosed to pollical nerve in 8 cases. Results Flaps in 5 cases underwent distal venous return block postoperatively, and there was non necrosis of the nap after proper measures including removal part of sutures and wiping the flap edge with the heparin-contained saline solution. After 13 months follow-up, all flaps survived with the recovery of protected sense, while the two point discrimination was 8 - 10 mm in the nerve anastomosis group. Conclusion It is a reliable choice to apply reverse flaps nutriented with dorsal nerve in reconstruction of soft tissue defects in distal end to the metacarpo-phalangeal joint of the thumb. Anastomosed nervess can recover the sense of the flaps.

关 键 词：拇指 皮神经 逆行皮瓣 修复 

分 类 号：R622[医药卫生—整形外科]