带血管蒂的邻指皮瓣修复手指末节皮肤脱套伤  

REPAIR OF DEGLOVING INJURY OF FINGERTIP WITH VASCULAR PEDICLED CROSS FINGER FLAP

作　　者：卢俊岳 崔浩杰 张巍 李启朝 何奎乐 彭永利 边朝辉 

机构地区：[1]任丘市人民医院手外科,河北任丘062550

出　　处：《中国修复重建外科杂志》2013年第12期1480-1483,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用指固有动脉背侧支供血的邻指皮瓣修复2~5指末节皮肤脱套伤的疗效。方法2010年1月-2012年6月,收治13例单指末节脱套伤患者。男9例,女4例;年龄17~46岁,平均33.6岁。致伤原因:机器绞伤4例,绳索绞伤6例,挤压伤3例。损伤指别:示指5例,中指3例,环指3例,小指2例。皮肤撕脱范围均为自远侧指间关节以远完全撕脱。脱套手指末节长度为1.0~2.1 cm,平均1.8 cm。合并指骨骨折2例。患者受伤至手术时间为90~330 min,平均150 min。应用大小为3.2 cm×2.3 cm^4.2 cm×3.1 cm的指固有动脉背侧支供血的邻指皮瓣修复,术后3~4周皮瓣断蒂。供区游离植皮修复。结果术后3例皮瓣出现张力性水疱,1例供区植皮部分坏死,均经对症处理后愈合;其余皮瓣及供区植皮均顺利成活,创面Ⅰ期愈合。13例患者均获随访,随访时间6~10个月,平均7个月。皮瓣外形满意,质地优良,色泽正常,无破溃。术后6个月,皮瓣两点辨别觉为7~10 mm,平均8.1 mm。采用手指总主动活动度评分法对手指功能进行评价,获优10例,良3例,优良率100%。结论以指固有动脉背侧支供血的邻指皮瓣修复2~5指末节皮肤脱套伤血供可靠,手术操作简便,皮瓣成活率高,术后皮瓣外观良好,患指功能恢复满意。Objective To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. Methods Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years （range, 17-46 years）. The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm （mean, 1.8 cm）. Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes （mean, 150 minutes）. The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm x 2.3 cm to 4.2 cm x 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months （mean, 7 months）. The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm （mean, 8.1 mm）. The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. Conclusion The treatment of ＆gloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appe

关 键 词：手指末节脱套伤 邻指皮瓣 指固有动脉背侧支 创面修复 

分 类 号：R658.2[医药卫生—外科学]