两种逆行岛状皮瓣修复拇指创面的对比研究  

A comparative study of two kinds of reverse radial flap for thumb soft tissue reconstruction

作　　者：赵刚 芮永军 糜菁熠 邱扬 姚群 柯尊山 

机构地区：[1]无锡市第九人民医院手外科,江苏省无锡市214062

出　　处：《中华显微外科杂志》2016年第2期110-113,共4页Chinese Journal of Microsurgery

基　　金：江苏省医学领军人才与创新团队项目（LJ201114）;无锡市科技发展资金项目（CSE32N1303）

摘　　要：目的比较分析拇指逆行桡背侧皮瓣和大鱼际逆行岛状皮瓣修复拇指创面的疗效差异，为临床选择皮瓣提供参考。方法2013年1月至2014年6月，随机采用这两种逆行岛状皮瓣修复拇指外伤性软组织缺损43例，其中拇指桡背侧皮瓣修复指端缺损8例、指腹缺损11例、指背缺损4例，大鱼际逆行岛状皮瓣修复指端缺损6例、指腹缺损11例，指背缺损3例；随访比较两组皮瓣的患者满意度评分、寒冷耐受评分、拇指活动度（TAM）、皮瓣感觉（痛觉、温度觉、单丝触觉、两点辨别觉）、皮瓣血流灌注量。结果拇指桡背侧皮瓣组患者满意度（36．97±7．70）％，寒冷耐受评分（58．96±12．47）分，关节活动度（87．57±12．83）°，单丝触觉中位数3．61mm，两点辨别觉（14．22±2．84）mm，血流灌注量（98．41±15．66）PU；大鱼际皮瓣组患者满意度（50．00±10．80）％，寒冷耐受评分（60．45±14．10）分，关节活动度（95．00±14．58）°单丝触觉中位数4．31mm，两点辨别觉（20．70±2．56）mm，血流灌注量（104．74±14．12）PU。大鱼际皮瓣患者满意度优于拇指桡背侧皮瓣患者（P〈0．05）；拇指桡背侧皮瓣单丝触觉和两点辨别觉均优于大鱼际皮瓣（P〈0．05），两组皮瓣痛觉和温度觉均有恢复；两组病例的拇指TAM、寒冷耐受评分、血流灌注量差异均无统计学意义（P〉0．05）。结论拇指桡背侧皮瓣由于有优良的感觉恢复，适合修复指腹等功能区：指背的非功能区的小面积缺损选择大鱼际皮瓣修复，可获得良好的患者满意度。Objective To evaluate the clinical results of the thumb dorsoradial flap and the greater thenar flap for coverage of thumb soft tissue defect, and to provide guidance on clinical selection of flaps. Methods From January, 2013 to June, 2014, 23 thumb dorsoradial flaps and 20 greater thenar flaps were used to repair the soft tissues defects in thumbs and were followed up to compare the results. Patient satisfaction, cold intolerance scores, TAM of the reconstructed thumb, sensation （pain and temperature sensation, Semmes-Weinstein monofilament test, static two-point discrimination） and blood peffusion of the flaps were recorded and analyzed statistically. Results Thumb dorsoradial flaps group： patient satisfaction was （36.97 ± 7.70）%, cold intolerance score was 58.96 ± 12.47, TAM of the thumb was （87.57 ± 12.83）°, median Semmes-Weinstein monofilament test was 3.61mm, static two-point discrimination was （14.22 ± 2.84）mm, and blood perfusion was （98.41 ± 15.66） PU. Greater thenar flaps group： patient satisfaction was （50.00 ± 10.80）%, cold intolerance score was 60.45 ±14.10, TAM of the thumb was （95.00 ± 14.58）°, median Semmes-Weinstein monofilament test was 4.31mm, static twopoint discrimination was （20.70 ±2.56）mm, and blood peffusion was （104.74 ± 14.12）PU. The greater thenar flap had a larger degree of satisfaction than the dorsoradial flap （P 〈 0.05）. Both pain and temperature sensation of the flap were regained in all cases, but the dorsoradial flap presented better Semmes-Weinstein monofllament score and static two-point discrimination（P 〈 0.05）. No differences were found regarding TAM of the thumb,cold intolerance score and blood perfusion of the flap （P 〉 0.05）. Conclusion The dorsoradial flap is suitable for repairing the thumb pulp defect due to its good sensation. For the small defect of non-functional dorsal area, the greater thenar flap will be a satisfactory method.

关 键 词：桡背侧皮瓣 大鱼际皮瓣 岛状皮瓣 拇指 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]