联合指端动脉弓的指固有血管神经束V-Y推进皮瓣修复儿童指端小面积皮肤软组织缺损  

Application of V-Y advancement flap pedicled with digital proper neurovascular bundle combined with arterial arch of the fingertip for repair of small area skin and soft tissue fingertip defects in children

作　　者：李海 常树森 魏在荣 刘志远 肖顺娥 周健 邓呈亮 聂开瑜 Li Hai;Chang Shusen;Wei Zairong;Liu Zhiyuan;Xiao Shun′e;Zhou Jian;Deng Chengliang;Nie Kaiyu(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Guizhou 563000,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州563000

出　　处：《中华手外科杂志》2020年第4期250-252,共3页Chinese Journal of Hand Surgery

基　　金：《穿支皮瓣对复杂创面修复的临床应用》临床专项,黔科合成果(20194441号);《间充质干细胞对皮瓣神经重建的实验研究》贵州省社发公关项目(黔科合支撑[2017]2877)。

摘　　要：目的探讨联合指端动脉弓的同指单侧指固有血管神经束V-Y推进皮瓣治疗儿童指端小面积皮肤软组织缺损的临床疗效。方法自2018年1月至2020年1月我科共收治10例12指指端软组织缺损患儿。缺损面积1.0 cm×0.8 cm^2.0 cm×1.8 cm。切取同指单侧指固有血管神经束联合指端动脉弓穿支皮瓣,皮瓣设计成"V"形,切口线设计为锯齿状,保留指端动脉弓交通支血管,向远端推进修复指端或指背甲床缺损伴指骨外露创面。皮瓣近端最远至掌指关节。结果术后10例12指皮瓣全部存活,创面均Ⅰ期愈合,皮瓣存活良好。随访3~24个月,平均10个月。患指无明显屈曲挛缩畸形,各关节活动正常,皮瓣区无感觉障碍。末次随访时患指关节屈曲功能按总主动活动度系统评分:优10指,良2指。结论携带指端动脉弓的指固有血管神经束V-Y推进皮瓣修复儿童远端小面积皮肤软组织缺损安全可靠,可操作性强。Objective To explore the clinical efficacy of V-Y advancement flap pedicled with digital proper neurovascular bundle combined with arterial arch of the fingertip for repair of small area skin and soft tissue fingertip defects in children.Methods From January 2018 to January 2020,10 children(12 fingers)with skin and soft tissue fingertip defects were treated.The defect area was 1.0 cm×0.8 cm to 2.0 cm×1.8 cm.The unilateral digital proper neurovascular bundle combined with arterial arch of the fingertip perforator flap at the same finger were cut.The flap was designed as"V"shape,and the incision line was designed as serrate shape.The communicating vessels of the arterial arch of the fingertip were preserved,and the defects of the fingertip or the nail bed of the dorsal finger with exposure of digital bone was repaired by flap advancement distally.The proximal end of the flap was farthest to the metacarpophalangeal joint.Results All the flaps of 12 fingers of 10 patients survived after operation.All the wounds achieved primary healing and the flaps survived well.The patients were follow-up for 3 to 24 months,with an average of 10 months.There was no obvious flexion contracture deformity in the affected finger,normal movement of each joint,and no sensory disturbance in the flap area.At the last follow-up,the flexion function of the affected finger joint was evaluated according to the total active motion system.The results were excellent in 10 fingers and good in 2 fingers.Conclusion The V-Y advancement flap pedicled with digital proper neurovascular bundle combined with arterial arch of the fingertip is safe,reliable and operable in th repair of small area skin and soft tissue fingertip defects in children.

关 键 词：指损伤 外科皮瓣 指固有动脉穿支 感觉重建 

分 类 号：R726.8[医药卫生—儿科]