“化整为零”的理念进行同指两叶皮瓣修复手指软组织缺损  

Clinical decentralization repair soft tissue defect in the distal phalanx with bilobular flaps of same finger

作　　者：江起庭 江志伟[2] 

机构地区：[1]巢湖紫晨手外科医院手外科中心,安徽巢湖238000 [2]南京军区南京总医院全军普外科研究所,江苏南京210002

出　　处：《实用手外科杂志》2012年第4期345-349,共5页Journal of Practical Hand Surgery

摘　　要：目的介绍“化整为零”的理念进行同指两叶皮瓣修复1～5指远节软组织缺损的方法。方法自2（105年2月-2012年2月，将52例52指远节软组织缺损的创面均看成两个小的缺损创面．第1指采用桡侧筋膜皮瓣为一叶修复桡侧缺损，尺侧皮神经营养血管皮瓣为另一叶修复尺侧缺损：第2～5指均以指动脉终末背支皮瓣为一叶（上叶）修复指背缺损，另一叶（下叶）分别以指动脉岛状皮瓣、指动脉近节背支皮瓣、指掌侧静脉动脉化岛状皮瓣三种皮瓣修复指掌侧缺损。结果52例双叶皮瓣全部成活．除少部分发生水疱的病例痂下愈合外，余大部分病例伤口均一期愈合，随访6～20个月（平均10．2个月），皮瓣质地优良，外形佳，各指关节运动尚可，按TAM系统评价：优45指，良6指。可2指，优良率96．2％。两点辨别觉4．0～8．5mm，平均6．2mm。感觉测定按BMRC评级标准为S2～S4级．平均S3级。结论该法是正确、可行的，切取简便，转移灵活，可一次性修复缺损，自由的掌控损伤，最大限度地降低供区损伤．皮瓣外形及感觉功能恢复好，为修复1～5指远节软组织缺损提供了全新的修复理念，值得推广。Objective To introduce the methods and effects with decentralization repairing soft tissue defect in the distal phalanx by bilobular flaps of same finger. Methods From February 2005 to February 2012, we treated 52 patients （52 fingers） with soft tissue defect in the distal plalanx from 1 to 5 finger.13 cases of patients with soft tissue defects in the thumb were covered radial defect by radial fasciocutaneous flap as a leaf, unlar neurocutaneous flap covered unlar defect as another leaf. 39 cases of patients with soft tissue defects from 2 to 5 finger were repaired distal dorsal of finger by end dorsal branches of digital artery inland flaps as a leaf, and digital artery island flaps or near dorsal branches of digital artery island flaps or superficial palmar digital venins arterilization island flaps repair finger palmar defect as another leaf. Results 52 patients were followed-up for 6-20 months with an average of 10.2 months. All cases survived successfully, all pulps presented with good shape, fine texture and joint motion of fingers was well. Two-point discrimination was 4.0-8.5mm, function of sensory was S2-S4. According to the total active movement evaluation system issued by the American Society for Surgery of the Hand in 1975,the results of this series were excellent in 44 cases, good in 6 cases and fair in 2 case,the good rate was 96.2%. Conclusion It is an good method to repair soft tissue defects in the distal phalanx, for its simple with less injury and easy to operate. Break up the whole into parts is new repairing idea, it is worthy of clinical using.

关 键 词：化整为零 同指 两叶皮瓣 缺损 修复 

分 类 号：R658.2[医药卫生—外科学]