近节指背动脉蒂邻指岛状皮瓣修复手指皮肤缺损  

Proximal dorsal digital artery pedicled island flaps for reconstruction of adjacent finger soft-tissue defect

作　　者：冯仕明[1] 王爱国[1] 张在轶 陶友伦[1] 周明明[1] 郝云甲[1] 孙擎擎[1] 

机构地区：[1]徐州市中心医院手足显微外科,221009

出　　处：《中华创伤杂志》2015年第6期540-543,共4页Chinese Journal of Trauma

摘　　要：目的探讨近节指背动脉蒂邻指岛状皮瓣修复手指皮肤缺损并重建感觉的临床治疗效果。方法选择2013年1月-2014年1月21例（21指）手指皮肤缺损患者，采用近节指背动脉蒂邻指岛状皮瓣进行修复并重建感觉。损伤指别：示指7例，中指9例，环指4例，小指1例。手指皮肤软组织缺损面积为1．9cm×1．5cm-4．3cm×2．3om。皮瓣切取面积为2．0cm×1．7cm-4．5cm×2．5cm。皮瓣供区均采用上臂内侧全厚皮片进行修复。术后观察皮瓣存活情况及修复外观，并检测两点辨别觉。根据手外科功能评分系统（TAM）对指功能进行评价。结果术后所有皮瓣及植皮成活。所有患者均获得6～18个月（平均14．7个月）随访。末次随访时，患指外观恢复满意，未见明显瘢痕挛缩或色素沉着，皮瓣供区饱满，未见明显凸起或凹陷，指蹼开大与健侧无明显差异，皮瓣两点辨别觉为5—9mm（平均6．3mm）。TAM评价：优19例，良2例，优良率为100％。结论携带指背神经的近节指背动脉蒂邻指岛状皮瓣修复手指皮肤缺损，具有成活率高、术后外观及感觉恢复满意、并发症少等优点，是治疗手指皮肤缺损较为理想的方法。Objective To assay the clinical effect of proximal dorsal digital artery pedicled island flap in treatment and sensory reconstruction of adjacent finger soft-tissue defect. Methods The study enrolled 21 cases of soft-tissue defect in 21 fingers treated from January 2013 to January 2014. All the defects were covered with the proximal dorsal artery pedicled island flaps raised from the adjacent finger. Index finger was injured in 7 patients, middle finger in 9 patients, ring finger in 4 patients, and little finger in 4 patients. Defect and flap dimensions varied from 1.9 cm × 1.5 em to 4. 3 cm × 2.3 cm and from 2.0 cm × 1.7 cm to 4. 5 cm × 2.5 cm respectively. Donor site was resurfaced with a full- thickness skin harvested from medial side of the upper arm. Postoperative flap appearance and two-point discrimination were evaluated. Total active motion （TAM） of the finger was evaluated after operation. Results All the flaps and skin grafts survived after operation. Duration of the follow-up was 6-18 months （mean, 14. 7 months ）. Through the final follow-up, appearance and function of the flap were satisfactory, donor site healed well, and two-point discrimination was 5-9 mm （mean, 6.3 mm）. TAM evaluation was excellent in 19 patients and good in 2 patients with the excellent-good rate of 100%. Conclusion The proximal dorsal artery pedicled island flap raised from the adjacent finger is an ideal choice in finger soft-tissue reconstruction, for the technique has advantages of high survival rate, satisfactory appearance and sensory function as well as few complications.

关 键 词：指 软组织损伤 外科皮瓣 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]