重建感觉的指侧方岛状皮瓣修复拇指指腹缺损  

REPAIR OF THUMB PULP DEFECTS WITH SIDE ISLAND FLAP COINCIDING DORSAL BRANCH OF DIGITAL NERVE

作　　者：杨焕友[1] 王斌[1] 卢爱东[2] 李瑞国[1] 陈超[1] 马铁鹏[1] 

机构地区：[1]唐山市第二医院手外科河北唐山,063000 [2]唐山市开滦医院外科

出　　处：《中国修复重建外科杂志》2014年第7期862-864,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨缝合指固有神经背侧支的指侧方岛状皮瓣修复拇指指腹缺损疗效。方法 2008年5月-2012年7月,采用缝合指固有神经背侧支的指侧方岛状皮瓣移位修复36例拇指指腹皮肤软组织缺损。其中男26例,女10例;年龄21~51岁,平均32.4岁。致伤原因:电锯伤14例,冲床压伤8例,机械绞伤5例,门挤伤5例,玻璃切割伤4例。左手12例,右手24例。均伴肌腱与骨外露,3例伴末节指骨骨折,2例伴甲床裂伤。缺损范围1.4 cm×1.2 cm^2.5 cm×2.1 cm;皮瓣切取范围1.8 cm×1.4 cm^3.0 cm×2.5 cm。结果术后2例皮瓣远端出现张力性水疱,表皮结痂,经换药后愈合;余34例皮瓣顺利成活,创面均Ⅰ期愈合。供区植皮均成活,切口Ⅰ期愈合。术后36例均获随访,随访时间3~15个月,平均8个月。皮瓣颜色与周围皮肤相似,皮瓣外观饱满,质地柔软;末次随访时两点辨别觉为4~8 mm,平均5.2 mm。患指关节无僵硬,根据中华医学会手外科学会上肢部分功能评定试用标准,皮瓣感觉S4 33例、S3+3例,皮瓣均无异位感。供指伸屈活动正常,供指皮瓣切取侧指端皮肤感觉均为S4。结论缝合指神经背侧支的指侧方岛状皮瓣解剖恒定,血供可靠,手术安全,且能有效克服传统指侧方岛状皮瓣的异位感,保护供指感觉功能,是一种修复拇指指腹缺损的较好方法。Objective To explore the ef ectiveness of the side island l ap coinciding dorsal branch of the digital nerve for repairing thumb pulp defects. Methods Between May 2008 and July 2012, 36 cases of thumb pulp defects were treated with the side island l ap coinciding dorsal branch of the digital nerve. There were 26 males and 10 females, aged 21-51 years（mean, 32.4 years）. The injury causes included electric saw injury in 14 cases, punch press injury in 8 cases, machine twist injury in 5 cases, door crushing injury in 5 cases, and glass cutting injury in 4 cases. The left hand was involved in 12 cases and the right hand in 24 cases. Combined injuries included tendon and bone exposure in all cases, fracture of the distal phalanx in 3 cases, and nail bed lacerations in 2 cases. The defect size ranged from 1.4 cm × 1.2 cm to 2.5 cm × 2.1 cm; and the l ap size ranged from 1.8 cm × 1.4 cm to 3.0 cm ×2.5 cm. Results Two l aps with distal skin l ap tension blisters and skin scabbing, which were cured after dressing changes; the wound healed by i rst intension in the other 34 cases. The skin grafts at donor site survived, and primary healing of incision was obtained. The patients were followed up 3-15 months（mean, 8 months）. The appearance and function restored well. Two-point discrimination of the l ap was 5.2 mm on average（range, 4-8 mm） at last follow-up. The i nger joint had no stif. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association, the sensation was S4 in 33 and S3＋ in 3 cases. No ectopic feeling was observed. The extension and l exion activity of i ngers at donor site was normal, the sensation reached S4 with no atrophy of the i nger. Conclusion With constant anatomy, reliable blood supply, and safe operation, the anastomoses of the i nger side island l ap with dorsal branch of digital nerve is a better method to repair thumb pulp defects because it also ef ectively overcome the ectopic feeling with traditional methods and

关 键 词：指侧方岛状皮瓣 拇指指腹缺损 感觉重建 

分 类 号：R658.2[医药卫生—外科学]