吻合指固有神经背侧支的远侧指间关节背侧穿支皮瓣修复手指末端组织皮肤缺损  

Anastomosis of dorsal branch of the proper digital nerve dorsal distal interphalangeal joint perforator flap to repair finger tip defect of skin tissue

作　　者：程邦君[1] 郑兆宽 刘志忠 黄俊伍[1] 罗轶[1] 

机构地区：[1]上海市第六人民医院金山分院骨科201599

出　　处：《中国综合临床》2017年第5期390-392,共3页Clinical Medicine of China

基　　金：上海市金山区卫生和计划生育委员会科研课题（JSKJ-KTQN-2015-09）

摘　　要：目的 总结应用指动脉远侧指间关节背侧穿支皮瓣修复手指末端皮肤缺损,并同时吻合指固有神经背侧支重建感觉的方法和效果.方法 选取2012年9月至2015年3月我院骨科收治手指末端皮肤缺损患者78例92指,均以指动脉远侧指间关节背侧皮支为血管蒂的指背皮瓣,逆行转移修复手指末端皮肤缺损,同时吻合指固有神经背侧支重建感觉.结果 术后发生血管危象8例,皮瓣部分坏死2例,经对症处理后愈合.余皮瓣全部存活,伤口均Ⅰ期愈合,供皮区均Ⅰ期愈合.随访73例79指,随访时间3.0~12.0个月,平均（7.8±2.5）个月.术后外形及感觉良好,质地柔软、耐磨、无触痛、耐寒冷.动态的两点辨别觉恢复至4.0~8.0 mm,平均（5.3±0.9） mm;静态的两点辨别觉4.0~9.0 mm,平均（5.8±1.2） mm.手功能关节总体活动度（TAM）法测定：优67指,良7指,可5指,差0指,优良率达93.7%.结论 该术式不牺牲手指主要血管和神经,采用中节指背非功能面皮肤为供区,并同时通过吻合指固有神经背侧支重建感觉,不需二次手术,为修复手指末端皮肤缺损较理想的术式之一.Objective To Summarize the application of digital artery dorsal distal interphalangeal joint perforator flap to repair finger tip skin defect,and at the same time,the method and effect of anastomosis of finger dorsal branch of digital nerve sensory reconstruction.Methods From September 2012 to March 2015,78 patients 92 fingers were treated in Orthopedics Department of Jinshan Branch Hospital of the Sixth People′s Hospital of Shanghai,all patients with finger artery distal interphalangeal joint dorsal cutaneous branches of the dorsal flap pedicled with retrograde,transferred to repair the skin defect of finger end,and anastomosis of dorsal branch of the proper digital nerve reconstruction.Results Postoperative vascular crisis occurred in 8 cases,2 cases of partial flap necrosis and healed after symptomatic treatment.All flaps survived,the wounds healed in I stage,and the donor site healed in I stage.All the 73 cases were followed up,the follow-up period ranged from 3.0 to 12.0 months,an average of （7.8±2.5） months.The postoperative appearance and feel good,soft texture,abrasion resistance,no tenderness,cold resistance,dynamic two-point recovered to 4.0-8.0 mm,average （5.3±0.9） mm.Static two-point discrimination was 4.0-9.0 mm,average （5.8±1.2） mm.The method of TAM was used to determine the function of the 67 fingers,good for the 7 finger,but also for the 5 finger and the difference of the 0 finger.The excellent and good rate was up to 93.7%.Conclusion The operation without sacrifice of major arteries and nerves by finger,the middle finger dorsal skin for non functional surface area,and at the same time by anastomosis of dorsal branch of the proper digital nerve reconstruction,without surgery two times,is one of the ideal surgical repair of skin defect of the finger end.

关 键 词：指动脉背侧支 穿支皮瓣 手指末端皮肤缺损 指固有神经 

分 类 号：R658.2[医药卫生—外科学]