改良蒂部切取的示指近节背侧岛状皮瓣修复拇指组织缺损  

Dorsal island flap of proximal segment of index finger with modified pedicle to repair thumb tissue defect

作　　者：李政 范爱民 唐加波 林祥 LI Zheng;FAN Aimin;TANG Jiabo(Department of Hand Sugery,The First People's Hospital of Zheryiang City,Jiangsu,212000,China)

机构地区：[1]镇江市第一人民医院手外科,江苏镇江212000 [2]中国人民解放军东部战区总医院镇江医疗区骨科,江苏镇江212000

出　　处：《实用手外科杂志》2020年第4期462-464,共3页Journal of Practical Hand Surgery

摘　　要：目的探讨采用改良的方法,将蒂部连同皮肤、皮下筋膜和神经血管作为整体一同切取的示指近节背侧岛状皮瓣修复拇指组织缺损创面。方法2013年1月-2019年9月,采用改良蒂部切取的示指近节背侧岛状皮瓣来治疗拇指组织缺损23例。结果术后23例皮瓣全部成活良好,17例获6~30个月的随访,平均11.2个月,6例失访。所有患者的皮瓣外形良好,无臃肿,质地柔软,感觉良好,静止两点辨别觉4.2~6.1 mm,平均4.9 mm。手指功能末次随访采用手指总主动活动度(TAM)法评定:优14指,良2指,可1指,优良率94.1%。拇指术后外观的满意度根据Michigan手外科问卷进行评定,非常满意15例,满意2例。结论改良蒂部切取的示指近节背侧岛状瓣是修复拇指创面的一种良好治疗方式,具有操作简单、手术风险低、术后皮瓣外形好、感觉功能恢复良好优点,值得推广。Objective To investigate clinical effect of modified first dorsal metacarpal artery flap,pedicle of the flap containing skin,subcutaneous fascia and neurovascular as a whole was harvested,to repair the tissue defect of thumb.Methods From January 2015 to September 2020,23 cases of thumb tissue defect were treated with modified first dorsal metacarpal artery flap.Results All flaps survived.17 patients were followed up for 6-30 months(average 11.2 months),6 cases were lost.The skin flaps had good elasticity,good appearance,no encumbrance and good feeling.The static two-point discrimination was 4.2-6.1 mm,with an average of 4.9 mm.At the final follow-up,according to the total active movement(TAM)standards used to evaluate finger function:excellent in 14 fingers,good in 2 fingers,fair in 1 finger,and the excellent and good rate was 94.1%.According to The Michigan Hand Outcomes Questionnaire,15 patients were very satisfied and 2 were satisfied with the appearance of the thumb.Conclusion The modified first dorsal metacarpal artery flap is a good treatment for the repair of thumb tissue defect,the advantages include easy manipulation,high success rate,good appearance of the flap and good sensory function of the thumb after operation,deserve the clinical expansion.

关 键 词：拇指 组织缺损 外科皮瓣 第1掌背动脉 

分 类 号：R658.2[医药卫生—外科学]