拇指指动脉逆行近节背侧皮瓣移植修复拇指指腹缺损  

The reverse homodigital dorsal thumb flap for thumb pulp defect reconstruction

作　　者：李根群 李国增 胡轶婷 姜素平 张焕宁 郭超 夏男男 李启朝 Li Genqun;Li Guozeng;Hu Yiting;Jiang Suping;Zhang Huanning;Guo Chao;Xia Nannan;Li Qichao(First Department of Orthopedics,the People’s Hospital of Renqiu,Renqiu 062550,China)

机构地区：[1]任丘市人民医院骨一科,任丘062550

出　　处：《中华整形外科杂志》2022年第3期311-315,共5页Chinese Journal of Plastic Surgery

摘　　要：目的总结拇指指动脉逆行近节背侧皮瓣移植修复拇指指腹缺损的效果。方法回顾性分析2010年3月至2020年6月任丘市人民医院采用拇指指固有动脉逆行近节背侧皮瓣修复拇指指腹缺损的患者资料。设计切取同指近节背侧岛状皮瓣,术中将供应皮瓣血运的穿支血管近端的指动脉切断结扎,以指动脉为蒂逆行转移修复拇指指腹缺损。以9-0无创缝合线将皮瓣携带的指背神经与指固有神经断端吻合。供区游离植皮修复。随访受区皮瓣、供区植皮存活情况,及修复指腹外观、感觉情况。结果共纳入68例拇指指腹缺损患者,均伴有末节指骨肌腱外露。男39例,女29例;年龄18~63岁,平均35.8岁。术中切取近节背侧岛状皮瓣大小为2.0 cm×3.0 cm~3.1 cm×4.2 cm。术后全部皮瓣及供区植皮均存活,创面一期愈合。68例患者均获随访,随访时间6~28个月,平均10.6个月。皮瓣外形不臃肿,指腹饱满,外观满意,感觉恢复良好,两点辨距觉为4~11 mm。结论采用拇指指动脉逆行近节背侧皮瓣修复拇指指腹缺损具有创伤小、手术操作简便等优点,能获得较好效果。Objective To summarize the effect of reverse homodigital dorsal thumb flap in repairing thumb pulp defect.Methods A retrospective case series study was conducted to analyze the clinical data of patients with thumb pulp defects admitted to the People's Hospital of Renqiu from March 2010 to June 2020.The dorsal homodigital island flap of the proximal phalanx was designed and harvested.During the procedure,the proximal digital artery of the perforator vessels of the flap was cut off and ligated.The digital artery pedicled flap was retrograde transferred to cover the thumb pulp defect.9-0 line was used to anastomose the dorsal digital nerve with the proper digital nerve.The donor site was repaired with a free skin graft.Results A total of 68 cases of thumb pulp defects were enrolled,all of whom were accompanied by exposure of the tendon of the distal phalanx.There were 39 males and 29 females,aged from 18 to 63 years(average of 35.8 years).The size of the proximal dorsal island flap was 2.0 cm×3.0 cm to 3.1 cm×4.2 cm.All flaps and skin grafts survived,and wounds healed primarily.All patients were followed up for 6 to 28 months(mean,10.6 months).The color,texture,and contour of the flaps were good.All repaired thumbs got the normal function of extension and flexion.At the last follow-up,the two-point discrimination of flaps was 4-11 mm.Conclusions It has the advantages of small trauma,simple operation,and good curative effect,using the homodigital dorsal thumb flap to repair the thumb pulp defect.

关 键 词：手损伤 拇指 外科皮瓣 穿支皮瓣 指固有动脉 拇指指腹缺损 

分 类 号：R658.2[医药卫生—外科学]