大鱼际桡侧筋膜蒂皮瓣修复拇指指尖缺损  

Repairing thumb tip defect with radial thenar fasciocutaneous flap

作　　者：林慧鑫 周望高 柯于海 曾锦浩 李东扬 李征 余少校 张振伟 LIN Huixin;ZHOU Wanggao;KE Yuhai;ZENG Jinhao;LI Dongyang;LI Zheng;YU Shaoxiao;ZHANG Zhenwei(Department of Hand Surgery,Shenzhen Hospital of Integrated Chinese and Western Medicine,Shenzhen,Guangdong Province 518104,China)

机构地区：[1]深圳市中西医结合医院手外科,广东深圳518104

出　　处：《中华显微外科杂志》2021年第4期384-387,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨采用大鱼际桡侧筋膜蒂皮瓣修复拇指指尖缺损的手术方法及临床效果。方法2016年3月至2019年1月,共收治外伤引起的拇指指尖缺损患者15例,其中左侧6例,右侧9例,创面均存在指骨外露,部分患者合并有骨质缺损,创面大小1.0 cm×2.0 cm〜1.5 cm×3.0 cm。均采用大鱼际桡侧筋膜蒂皮瓣修复创面,皮瓣面积1.2 cm×2.5 cm〜1.8 cm×4.0 cm,供区创面直接闭合。术后通过门诊复查、电话及微信等方式进行随访,观察皮瓣成活质量及供区伤口愈合情况,并评价临床效果。结果术后皮瓣均顺利成活,供区伤口I期愈合。所有患者均获得随访,时间为6〜18个月,平均10.5个月。门诊末次复查皮瓣外形无臃肿,色泽自然,质地柔韧、耐磨性好,皮瓣感觉均有不同程度恢复,TPD为6〜12 mm,皮瓣供区周围皮肤感觉接近正常,拇指功能活动恢复良好,按手指总主动活动度(TAM)法评定:优12例,良3例。结论采用大鱼际桡侧筋膜蒂皮瓣修复拇指指尖缺损,皮瓣质地接近受区,供区创伤小,临床效果良好。Objective To investigate the surgical method and clinical effect in the repair of thumb tip defect with radial thenar fasciocutaneous flap.Methods From March,2016 to January,2019,15 patients with thumb tip defect were treated by radial thenar fasciocutaneous flap.There were 6 defects in left thumb and 9 in right thumb.All the thumbtip defects had the exposure of digital bone,and some had defects of digital bone itself.The size of defects ranged from 1.0 cm×2.0 cm to 1.5 cm×3.0 cm,and the size of the flaps ranged from 1.2 cm×2.5 cm to 1.8 cm×4.0 cm.All of the donor sites were directly closed.The patients entered follow-up by outpatient visit,telephone calls or WeChat reviews to evaluate the quality of the flaps and the clinical effects of the surgery.Results All flaps sur-vived with good quality.All the donor sites achieved primary healing.The follow-ups lasted for 6 to 18 months with an average of 10.5 months.At the final follow-up review,the appearance of flaps was satisfactory in natural colour,flexible and wear-resistant.There were various degrees of sensation recovery of the flaps,with TPD from 6 mm to 12 mm.The sensation around the donor site was close to normal.Function of the thumbs was evaluated according to the total active movement(TAM)evaluation system.Twelve thumbs were graded excellent and 3 in good.Conclusion The radial thenar fasciocutaneous flap achieved satisfactory clinical effect in the repair of thumb tip defect.The texture of the flaps is close to the recipient site and the damage to the donor site is minimal.

关 键 词：拇指指尖缺损 筋膜蒂皮瓣 修复 大鱼际 

分 类 号：R658.2[医药卫生—外科学]