游离第2趾趾背甲皮瓣联合(足母)趾腓侧皮瓣修复单指脱套伤  

Repair of degloving injury of single finger with free the second toe dorsal nail flap combined with fibular flap of great toe

作　　者：于斌 钱达 王柯 沈国良[2] 许明 YU Bin;QIAN Da;WANG Ke(Department of Burn Reshaping-Hand Surgery,Changshu Hospital Affiliated to Soochow University,The First People's Hospital of hangshu,Changshu,Jiangsu,215500,China)

机构地区：[1]苏州大学附属常熟医院常熟市第一人民医院烧伤整形-手外科,江苏常熟215500 [2]苏州大学附属第一医院烧伤整形外科,江苏苏州215000

出　　处：《实用手外科杂志》2021年第3期330-332,共3页Journal of Practical Hand Surgery

摘　　要：目的以第1跖背动脉为蒂,联合应用第2趾趾背甲皮瓣及(足母)趾腓侧皮瓣修复单指脱套伤,探讨该皮瓣在单指脱套伤中治疗的临床效果。方法回顾性分析2017年8月-2019年8月苏州大学附属常熟医院收治的15例15指单指脱套伤的临床资料,采用游离第2足趾趾背甲皮瓣联合(足母)趾腓侧皮瓣修复,缺损平面均在近侧指间关节以远,缺损长度2.8~4.5 cm,指脱套伤创面皮肤、软组织缺损范围为2.8 cm×5.5 cm~4.5 cm×6.5 cm。结果术后15例15指皮瓣均顺利成活,仅1例供区植皮部分坏死,经换药后愈合。15例均获得完整随访。随访时间为6~12个月,平均8个月,患指皮瓣颜色、外形、感觉及功能恢复接近健侧指。供区无明显瘢痕增生及挛缩,未出现不耐磨及疼痛等情况。结论应用游离第2趾趾背甲皮瓣联合(足母)趾腓侧皮瓣修复单指脱套伤,能较好地覆盖缺损创面,保证手指的外观、感觉及功能,同时可减少供区数量,减小损伤,是较理想的修复术式。Objective To investigate the clinical effect by using free second toe dorsal nail flap combined with fibular flap of great toe on repairing degloving injury of single finger,which uses the dorsal digital artery of the second toe as the pedicle.Methods From August 2017 to August 2019,15 cases of single finger degloving injury were treated in Changshu Hospital Affiliated to Suzhou University and they were all repaired with free second toe dorsal nail flap combined with fibular flap of great toe.The defect plane was located far from the proximal interphalangeal joint,and the length of the defect was about 2.8~4.5 cm.The skin and soft tissue defects of degloving injury ranged from 2.8 cm×5.5 cm to 4.5 cm×6.5 cm.Results All the flaps survived successfully.Only 1 case had partial necrosis of skin graft in donor site and healed after dressing change.All 15 cases were followed up completely.The average follow-up time was 8 months(range,6-12 months).The color,shape,sensation and function of the flaps were similar to the opposite healthy finger.There was no obvious scar hyperplasia and contracture,no wear resistance and pain.Conclusion The application of the second toe dorsal nail flap combined with the fibular flap of great toe to repair the degloving injury of single finger can cover the defect wound and ensure the appearance,feeling and function of the finger.It can also reduce the number of donor sites and injury.So it is an ideal repair method.

关 键 词：指 脱套伤 外科皮瓣 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]