带血管蒂的邻指皮瓣修复手指末节离断伤  

Pepair of amputation 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]任丘市人民医院骨二科,河北任丘062550

出　　处：《实用手外科杂志》2016年第1期56-58,共3页Journal of Practical Hand Surgery

基　　金：河北省沧州市科技计划项目（项目编号：151302131）

摘　　要：目的 探讨采用指固有动脉背侧支供血的邻指皮瓣包裹断指指骨修复2-5指末节离断伤的疗效。方法2013年6月-2014年6月，收治8例单指末节离断伤患者。将患指残端的残留甲床彻底去除，并剔除离断末节的毁损组织，保留指骨。直视下复位后用一枚0．8mm或1．0mm克氏针固定，采用指动脉背侧支供血的邻指皮瓣包裹断指指骨，皮瓣切取范围2．3cm×3．2cm～3．1cm×3．5cm，术后3～4周断蒂。供区游离植皮修复。结果术后1例皮瓣出现张力性水疱，对症处理后愈合，其余皮瓣、植皮均顺利成活，创面I期愈合。8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，无破渍。术后6个月，皮瓣两点辨别觉为8～12mm，平均9．1mm。手指功能采用手指总主动活动度（total active movement，TAM）评分法进行评价，优6例，良2例。结论 对于手指末节离断伤，保留末节指骨复位固定，再以指动脉背侧支供血的邻指皮瓣包裹断指指骨修复，术后血供可靠，手术操作简便，皮瓣成活率高，且外观良好，患指功能恢复满意。Objective To investigate the clinical efficacy of cross finger flap pedicled with the dorsal branches of proper digital artery in repairing amputation of the fingertip. Methods From June 2013 to June 2014, 8 cases of amputation of fingertip of single finger were treated. To remove the residual nail bed at the end of the finger. To remove the residual nailbed at the end of the finger. After Removing damaged tissue, retained phalanx, the phalanx reset with a 0.8 mm or 1.0 mm kirschner wire fixation. The cross flap was harvested from the dorsal of contiguous digital of their middle and proximal segment. The size of flaps ranged from 3.2 cm×2.3 cm to 3.5 cm×3.1 cm. After 4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters on the flap occurred in 3 cases, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Eight patients were followed up 6-10 months （mean, 7 months）. The texture and appearance of all the flaps were satisfactory. 6 months after operation, two-point discrimination ranged from 8 to 12 mm （mean, 9.1 mm）. The total active movement of the fingers were excellent in 6 cases and good in 2 cases. Conclusion The treatment of amputation injury of fingertip with retained phalanx and 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 appearance.

关 键 词：手指末节离断伤:邻指皮瓣 指固有动脉背侧支 

分 类 号：R658.1[医药卫生—外科学]