[足母]甲瓣与瓦合中指及环指相邻侧岛状皮瓣两种方式修复拇指末节脱套伤的疗效观察  

Effect of hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of degloving injury of distal thumb

作　　者：刘刚义 张锦涛 杨伟超 张洁 王春旭 李建梅 李晓妮 王芳 LIU Gangyi;ZHANG Jintao;YANG Weichao;ZHANG Jie;WANG Chunxu;LI Jianmei;LI Xiaoni;WANG Fang(Department of Hand and Microsurgery,Baoji Third Hospital,Baoji,Shanxi Province 721000,China)

机构地区：[1]宝鸡第三医院手显微外科,陕西宝鸡721000

出　　处：《中华显微外科杂志》2022年第4期366-371,共6页Chinese Journal of Microsurgery

摘　　要：目的观察并总结分别应用游离甲瓣与瓦合中、环指相邻侧岛状皮瓣移植修复拇指末节脱套伤的临床疗效和手术适应证。方法 2009年5月至2021年5月, 宝鸡第三医院手显微外科共收治拇指末节脱套伤共24例24指, 根据患者的意愿、职业等选择两种方式进行修复, 其中13例采用游离甲瓣移植修复(甲瓣组),11例采用带同一掌侧指总动脉血管蒂的中指尺侧和环指桡侧指掌侧固有动脉岛状皮瓣瓦合修复(瓦合皮瓣组)。术后通过门诊、电话或微信分别于1、3、6、12、18个月等时间段随访, 主[足母]要随访皮瓣的外形、色泽、质地和TPD, 以及拇指屈、伸、对掌及抓捏功能, 并参照中华医学会手外科学会上肢部分功能评定试用标准评定功能恢复情况。结果术后24例皮瓣均成活, 并均获得随访。[足母]甲瓣组和瓦合皮瓣组随访时间分别为12~60(18.5±0.5)个月和6~18(6.8±0.3)个月。末次随访指体外形及功能:[足母]甲瓣组均恢复了指甲、指腹螺纹及精细感觉,TPD为5~8 mm;拇指屈、伸、对掌及抓捏功能良好;瓦合皮瓣组除无指甲、指腹螺纹外, 皮瓣外形、质地良好, 也恢复了保护性感觉;TPD为6~11 mm;患指也恢复了屈、伸、对掌及抓捏等基本功能。参照中华医学会手外科学会上肢部分功能评定试用标准:[足母]甲瓣组优7例, 良5例, 可1例;瓦合皮瓣组优3例, 良5例, 可3例。从皮瓣外形(如指甲、指腹螺纹)、精细感觉恢复及抓捏功能的准确度、稳定性等方面观察,[足母]甲瓣组明显优于瓦合皮瓣组。供区均无功能影响。结论两种皮瓣均为移植修复拇指末节脱套伤的经典术式。对指体恢复要求高特别是爱美或职业需求的群体, 采用游离[足母]甲瓣修复, 可恢复其完美外形及功能;对不愿牺牲足趾或对指体外形要求不高的中老年群体采用瓦合皮瓣修复恢复指体功能, 可达到满足个体需求、提高疗效的目�Objective To summarise the clinical efficacy and surgical indications for free hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of distal thumb degloving injuries.Methods From May 2009 to May 2021,a total of 24 patients(24 digits)with degloving injury of distal thumbs were treated in the Department of Hand and Microsurgery of Baoji Third Hospital.The flap was selected according to the patient's wishes and occupation.Of the 24 patients,13 were repaired by free hallux toe nail flap transfer(group of hallux toe nail flap),and 11 were repaired by combining the proper palmar digital artery island flap of middle(ulnar side)and ring(radial side)fingers with the same volar common digital artery vascular pedicle(group of tile combined flap).Follow-up was performed at the 1st,3rd,6th,12th and 18th months after surgery respectively through outpatient clinic and telephone or WeChat interviews.The follow-ups focused on the appearance,colour,texture and two-point discrimination(TPD)of the flap,as well as thumb flexion,extension,opposition and grasping functions.Functional recovery evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results All the 24 flaps survived and all were included in the follow-up.The follow-up lasted 12-60 and 6-18 months,with an average of(18.5±0.5)months and(6.8±0.3)months in group of hallux toe nail flap and group of tile combined flap,respectively.Appearance of thumb body and function at the last follow-up showed:in the group of hallux toe nail flap,the nails,thumbtips and fine sensations were restored,with the TPD at 5-8 mm.The thumb flexion,extension,opposition and grasping functions were good.Apart from without nails and fingerprint,the flaps in the group of tile combined flap had good appearance and texture,and the protective feeling was restored with the TPD at 6-11 mm.The affected thumbs also recovered the basic functions of flexion,extension,opposition and grasping.According to t

关 键 词：脱套伤 [足母]甲瓣 瓦合皮瓣 指掌侧固有动脉岛状皮瓣 拇指末节 创面修复 

分 类 号：R658.2[医药卫生—外科学]