两种手部带蒂逆行皮瓣修复手指软组织缺损的疗效分析  

Efficacy of two reverse pedicle flaps for repairing soft tissue defects of the finger

作　　者：夏雷[1] 许玉本[1] 张红星[1] 李鹏[1] 黄良库[1] 

机构地区：[1]西安交通大学医学院附属红会医院手外二病区,西安710054

出　　处：《中华显微外科杂志》2017年第2期134-138,共5页Chinese Journal of Microsurgery

摘　　要：目的观察应用两种带蒂逆行皮瓣修复手指软组织缺损的疗效分析。方法此项前瞻性研究从2011年4月至2015年3月，共有46例患者纳入研究，所有病例均为除拇指外的手指皮肤及软组织缺损，将手指末梢血运差需要再植手术及皮肤缺损面积大于4.0 cm ×3.0 cm的病例排除；并将所有患者编号，利用随机数字表随机分为两组，其中掌背动脉穿支皮瓣组28例，指掌侧固有动脉背侧支为蒂逆行岛状皮瓣组18例，术后对皮瓣的并发症、成活率、手的功能恢复及外观进行对比分析。结果掌背动脉穿支组和指掌侧固有动脉背侧支组分别平均随访18、15个月，所有皮瓣全部成活；掌背动脉穿支组修复指端缺损8例，指掌侧固有动脉背侧支组修复指端缺损16例。掌背动脉穿支组修复指端缺损的8例患者中有2例早期出现静脉危象，2例出现皮瓣浅表坏死，其余病例均成活良好；指掌侧固有动脉背侧支为蒂逆行岛状皮瓣组修复指端缺损中有1例患者出现水疱；两组所有病例感觉恢复良好，掌背动脉穿支组两点辨别觉为6.0-9.0 mm，平均（7.1±0.5）mm；指掌侧固有动脉背侧支组两点辨别觉为4.0-7.0 mm，平均（5.2±0.4）mm，两组均达到S3＋级以上，但两组两点辨别觉差异有统计学意义（P 〈 0.05）；两组各指指间关节活动与健侧相比，差异无统计学意义（P 〉 0.05）。掌背动脉穿支组10例高出正常皮面5 mm,指掌侧固有动脉背侧支组仅1例，差异有统计学意义（P 〈 0.05）。结论掌背动脉穿支皮瓣和指掌侧固有动脉背侧支皮瓣血供安全、可靠，是修复手指缺损的理想皮瓣；对于手指指端缺损的修复，考虑到指端的感觉功能和外观，指动脉背侧支皮瓣优于掌背动脉穿支皮瓣。ObjectiveTo observe the effect of two reverse pedicle flap repaired soft tissue defect of the finger.MethodsFrom April, 2011 to March, 2015, 46 patients were randomly divided into two groups. Twenty-eight cases were performed by dorsal metacarpal artery flaps with cutaneous branches as pedicle and the 18 cases were performed by reverse the proper palmar digital artery dorsal branches island flap. The complication, survival rate, hand function and appearance were analyzed.ResultsThe dorsal metacarpal artery flaps with cutaneous branches as pedicle and reverse the proper palmar digital artery dorsal branches island flap were an average follow-up of 18 and 15 months, all flaps survived. For fingertip defects, 8 cases were repaired with as pedicle as the dorsal metacarpal artery flaps with cutaneous branches as pedicle while 16 cases were repaired with reverse the proper palmar digital artery dorsal branches island flap. Among them, complication included 2 cases of early venous congestion and 2 cases of superficial skin necrosis. One case of reverse the digital artery dorsal branches island flap blistered; the flap sensibility was good recovery. The two-point discrimination testing of dorsal metacarpal artery flaps with cutaneous branches as pedicle was from 6.0 to 9.0 mm （average of 7.1 ± 0.5 mm）; the two-point discrimination testing of dorsal metacarpal artery flaps with cutaneous branches as pedicle was from 4.0 to 7.0 mm（average of 5.2 ± 0.4 mm）, but there were differences in two-point discrimination and there was statistically significant（P 〈 0.05）. There was no significant difference between the two groups each finger interphalangeal joint activity compared with the healthy side. The study found that 10 cases of dorsal metacarpal artery flaps appearance was 5 mm higher than normal skin and 1 patient of reverse the digital artery dorsal branches island flap appearance was 5 mm higher than normal skin, the difference was statistically significant （P 〈 0.05）, the latter was better than the fo

关 键 词：手指 外科皮瓣 掌背动脉 指掌侧固有动脉 

分 类 号：R658.2[医药卫生—外科学]