两种逆行拇指背侧皮瓣修复拇指末节软组织缺损的对比研究  

A comparative study of two kinds of reverse dorsal thumb flaps for distal thumb soft tissue reconstruction

作　　者：荣向科 石定 刘刚义 宋永斌 谢瑞菊 刘宗义 RONG Xiang-ke;SHI Ding;LIU Gang-yi;SONG Yong-bin;XIE Rui-ju;LIU Zong-yi(Department of Burn,Plastic and Microsurgery,The 987th Hospital of The Joint Logistic Support Force of the CPLA,Baoji,Shaanxi,721000,China)

机构地区：[1]解放军联勤保障部队第九八七医院烧伤整形显微外科,宝鸡721000 [2]宝鸡市第三人民医院手显微外科,陕西721000

出　　处：《中国骨与关节杂志》2021年第12期956-960,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨采用拇指尺背侧皮瓣和桡背侧皮瓣移植修复拇指末节皮肤软组织缺损的手术情况和临床效果差异。方法回顾2015年3月至2018年8月,采用拇指背侧皮瓣修复拇指末节皮肤软组织缺损的28例,其中采用拇指尺背侧皮瓣移植修复13例,拇指桡背侧皮瓣修复15例。比较两组患者手术时间,皮瓣蒂部宽度,切取面积,术后皮瓣成活率,拇指外观,关节活动度和两点辨距觉水平差异。结果两组手术操作时间、关节活动度及患者满意度差异无统计学意义(P>0.05);切取面积:拇指桡背侧(51.13±2.95)大于尺背侧(49.84±2.82),(P<0.05);皮瓣蒂部宽度:尺背侧(4.92±0.76)较桡背侧窄(8.53±1.25),(P<0.05);两组皮瓣痛觉和温度觉均有恢复;两点辨距觉:尺背侧皮瓣(8.46±0.66)优于桡背侧皮瓣(10.60±1.12),(P<0.05)。结论拇指尺背侧皮瓣更适合修复面积相对较小的拇指尺侧、指端等功能区损伤创面,可更好的恢复感觉,但对于面积较大的缺损、桡侧创面或者非功能区,则以桡背侧皮瓣修复为宜。Objective To investigate the differences between dorsal ulnar flap and dorsal radial flap in the repairing of soft tissue defect of the distal thumb.Methods From March 2015 to August 2018,28 patients with soft tissue defect of the distal thumb were repaired,including 13 cases with dorsal ulnar flap and 15 cases with dorsal radial flap.The operation time,flap pedicle width,cut area,postoperative flap survival rate,thumb appearance,range of motion and two-point distance perception were compared between the two groups.Results There were no significant differences in operation time,range of motion and patient satisfaction between the two groups(P>0.05);the resection area of dorsal radial flap of the thumb was larger than that of dorsal ulnar flap(P<0.05);the pedicle width of dorsal ulnar flap was narrower than that of dorsal radial flap(P<0.05).The sense of pain and temperature of the flap recovered in both groups,and the two-point distance perception of dorsal ulnar flap was better than that of dorsal radial flap(P<0.05).Conclusions Dorsal ulnar flap is more suitable for the repairing of injuries in functional areas such as ulnar and fingertip of the thumb with relatively small area and better sensation.However,dorsal radial flap is recommended in the repairing of large defects,radial wounds or non-functional areas.

关 键 词：拇指 外科皮瓣 显微外科 软组织缺损 

分 类 号：R681.7[医药卫生—骨科学]