带双侧指掌侧固有神经背侧支的指背皮瓣修复手指掌侧软组织缺损  

Reconstruction of palmar soft tissue defect of digits using dorsal digital flap with bilaterally dorsal branch of proper palmar digital nerve

作　　者：陈超 张旭[2] 王斌[3] 王辉[3] 庄永青 CHEN Chao;ZHANG Xu;WANG Bin;WANG Hui;ZHUANG Yongqing(Department of Hand Surgery,Shenzhen People's Hospital,The Second Clinical Medical College of Ji’nan University,Hand Microvascular Surgery of the First Affiliated Hospital of Southern University of Science and Technology,Shenzhen,Guangdong Province 518020,China;Department of Hand Surgery,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Hand Surgery,The Second Hospital of Tangshan,Tangshan,Hebei Province 063000,China)

机构地区：[1]深圳市人民医院手外科,暨南大学第二临床医学院,南方科技大学第一附属医院手显微血管外科,广东深圳518020 [2]河北医科大学第三医院手外科,石家庄050051 [3]唐山市第二医院手外科,河北唐山063000

出　　处：《中华显微外科杂志》2021年第5期483-486,共4页Chinese Journal of Microsurgery

摘　　要：目的报道带双侧指掌侧固有神经背侧支(DBPPDN)的指背皮瓣修复手指掌侧软组织缺损的临床效果。方法2005年5月-2019年4月,收治手指掌侧软组织缺损113例113指。临床应用4种带双侧DBPPDN的指背皮瓣修复此类软组织缺损。皮瓣类型:①超比例邻指皮瓣29例29指。②指掌侧固有动脉背侧支(DBPPDA)皮瓣43例43指。③第1掌背动脉皮瓣23例23指。④指背游离皮瓣18例18指。采用带单侧DBPPDN的指背皮瓣进行修复的患者列为对照组,双侧撕脱的指掌侧固有神经仅修复一侧。经门诊随访,评估带双侧DBPPDN的指背皮瓣与对照组皮瓣的静态TPD、伤指VSA评分和患者满意度评分。采用非配对t检验进行分析,P<0.05为差异有统计学意义。结果带双侧DBPPDN的指背皮瓣有11例术后出现水疱,7例皮瓣瘀血。9例皮瓣远端部分坏死,经换药后自行愈合,余均成活。带双侧与带单侧DBPPDN的指背皮瓣的静态TPD分别为(6.92±0.12)mm和(8.92±0.20)mm、视觉模拟评分(VAS)分别为(0.46±0.08)分和(1.11±0.28)分,满意度评分分别为(4.45±0.06)分和(4.00±0.16)分,两组差异均有统计学意义,表明带双侧DBPPDN的指背皮瓣获得了更好的感觉恢复(P<0.01)、更低的疼痛发生率(P=0.0032)以及更高的满意度(P=0.0014)。结论4种带双侧DBPPDN的皮瓣是有效修复指掌侧软组织缺损的方法,尤其在预防神经病理性疼痛方面疗效显著。Objective To describe the reconstruction of palmar soft tissue defect of digit using dorsal digital flaps including double dorsal branches of the proper palmar digital nerves(DBPPDN)and report the results of the application of the flaps.Methods From May,2005 to April,2019,a retrospective study was conducted on 113 digits of 113 patients who had palmar soft tissue defects in single digit treated with 4 types of dorsal digital flaps with bilaterally DBPPDN.Flap types:①Modified cross-digit flap in 29 digits of 29 cases;②Dorsal digital flap based on the dorsal branch of proper palmar digital artery(DBPPDA)in 43 digits of 43 cases;③First dorsal metacarpal artery flap in 23 digits of 23 cases;④Free dorsal digit flap in 18 digits of 18 cases.In control group,single-innervated flap was used for repair of the defects,only one of injured proper palmar digital nerves on both sides was repaired with DBPPDN.Static TPD,VAS and patient satisfaction of the injured digits were evaluated by means of outpatient follow-up.The t test was applied to compare the 2 groups in relation to the quantitative outcomes.P<0.05 was considered statistically significant.Results In the dual-innervated flap group,flap ischemia was shown in 11 digits and venous congestion was noted in 7 digits.Partial necrosis was noted in 9 flaps and healed without surgical intervention.In the dual-innervated and single-innervated flap groups,the mean static TPD were(6.92±0.12)mm and(8.92±0.20)mm,the score of VAS were(0.46±0.08)and(1.11±0.28),and patient satisfaction were(4.45±0.06)and(4.00±0.16).Significant difference was found between the 2 groups in static TPD,VAS and patient satisfaction.Dual-innervated flaps presented better discriminatory sensation on the flap(P<0.01)and lower pain incidence(P=0.0032)and higher patient satisfaction(P=0.0014).Conclusion The 4 types of dual-innervated flap are useful in reconstruction of palmar soft tissue defects of digits,especially in prevention of neuropathic pain.

关 键 词：指背皮瓣 手指 指掌侧固有神经背侧支 指掌侧固有动脉背侧支 修复 

分 类 号：R658.2[医药卫生—外科学]