缝合双侧神经带感觉岛状皮瓣重建指腹缺损  

Finger pulp reconstruction with innervated reverse digital artery flap through bilateral neurorrhaphy

作　　者：赵刚[1] 芮永军[1] 糜菁熠 邱扬[1] 姚群[1] 柯尊山[1] 华雍[1] 

机构地区：[1]无锡市第九人民医院,无锡市手外科医院手外科,江苏214062

出　　处：《中华手外科杂志》2016年第6期443-445,共3页Chinese Journal of Hand Surgery

基　　金：无锡市卫生局青年科研项目（Q201509）;无锡市科技发展指导性计划（CSZON1502）

摘　　要：目的探讨缝合双侧神经的带感觉的指动脉逆行岛状皮瓣修复手指末节指腹缺损的临床疗效。方法自2014年4月至2015年3月，对15例17指末节指腹缺损伴指骨外露的创面，在近节指侧方设计指动脉逆行岛状皮瓣修复创面，皮瓣携带发自指固有神经的2支神经皮支，并沿主干作干支分离，皮瓣转移至创面后将皮支与创面双侧指神经残端缝合，重建皮瓣的感觉。结果15例17指皮瓣及供区植皮均完全存活，随访时间7～11个月。皮瓣外观良好，无明显臃肿，无明显色素沉着，质地柔软，手指各关节活动无明显受限。所有皮瓣均恢复了痛觉和温度觉，两点分辨觉5～8mm，单丝触觉3．22～3．84。采用CISS（cold intolerance severity score）问卷评定手指寒冷耐受情况，平均23分（11～44分），其中轻度不耐寒15指，中度不耐寒2指。按中华医学会手外科学会上肢部分功能评定试用标准评定：优14指，良2指，可1指。结论采用缝合双侧神经的带固有神经皮支的岛状皮瓣修复手指末节指腹缺损，可恢复手指良好的外观和感觉功能。Objective To investigate the clinical outcomes of finger pulp reconstruction with innervated reverse digital artery flap with the sensory nerve branches through bilateral neurorrhaphy. Methods From April 2014 to March 2015, innervated reverse digital artery flaps with the sensory branches of proper digital nerves were transferred to repair pulp defects of 17 fingers in 15 patients. The flap was designed at the lateral aspect of the proximal phalanx. Two branches of the proper digital nerve that projected towards the flap were included in the flap. After flap inset, these two branches were coapted with the stumps of the bilateral proper digital nerves. Results All the flaps and skin grafts survived uneventfully. These cases were follow-up for 7 to 11 months. The reconstructed pulps had good appearance and supple texture. There was no flap bulkiness or pigmentation. The involved fingers recovered normal active motion. The pain and temperature sensation were recovered in all the flaps. Static two-point discrimination value was 5 to 8 mm, while the average Semmes- Weinstein monofilament score was 3.22 to 3.84. The average Cold Intolerance Severity Score （CISS） was 23 （range, 11 to 44）, with 15 patients corresponded to mild cold intolerance and 2 patients corresponded to moderate cold intolerance. According to the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society, the results were rated as excellent in 14 fingers, good in 2 fingers, and fair in 1 finger. Conclusion Satisfactory appearance and sensation of finger pulp can be restored by transferring innervated reverse digital artery island flap with bilateral neurorrhaphy to the branches of the proper digital nerves.

关 键 词：外科皮瓣 指损伤 治疗结果 神经缝合 

分 类 号：R658.2[医药卫生—外科学]