带神经指背动脉逆行岛状皮瓣修复拇指末节脱套伤  

Repair of degloving injury of distal thumb with innervated reversed dorsal digital artery island flap

作　　者：王辉[1] 杨晓溪 霍永鑫[1] 费小轩[1] 安晓飞 杨山辉 李骏然 Wang Hui;Yang Xiaoxi;Huo Yongxin;Fei Xiaoxuan;An Xiaofei;Yang Shanhui;Li Junran(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan 063000,China;College of Traditional Chinese Medicine,North China University of Science and Technology,Tangshan 063210,China)

机构地区：[1]唐山市第二医院手外科,唐山063000 [2]华北理工大学中医学院,唐山063210

出　　处：《中华医学美学美容杂志》2022年第6期505-508,共4页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：河北省高层次人才资助项目(A201901124);河北省医学科学研究课题计划项目(20201453);河北省医学适用技术跟踪项目(GZ2021030)。

摘　　要：目的探讨同指带指背神经的指背动脉逆行岛状皮瓣修复拇指末节脱套伤的效果。方法2016年7月至2019年6月,唐山市第二医院手外科收治拇指末节脱套伤患者15例,男9例、女6例;年龄41~65岁,平均49岁。绞伤8例、压砸伤7例,4例合并末节指骨骨折;创面面积3.5 cm×1.8 cm~4.6 cm×2.4 cm,皮瓣切取面积3.8 cm×2.1 cm~5.0 cm×2.7 cm;用同指带指背神经的指背动脉逆行岛状皮瓣进行修复。术后随访观察皮瓣成活、外观、感觉恢复及伤指功能情况。结果15例患者术后皮瓣全部成活,无伤口感染及血运危象发生。所有患者随访9~22个月,平均16个月。皮瓣外观良好,色泽、质地与周围组织相近;骨折4~6周愈合。末次随访,皮瓣静态两点辨别觉为5~10 mm,平均7.8 mm。拇指功能优9例、良6例。拇指背侧供区仅残留轻微线性瘢痕。结论带神经的指背动脉逆行岛状皮瓣,操作简便、供区损伤小,适用于治疗不接受带趾甲足趾游离移植的中老年患者。Objective To investigate the clinical outcomes of homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve to repair degloving injury of distal thumb.Methods From July 2016 to June 2019,a total of 15 cases(15 thumbs)with degloving injury of distal part were admitted to the Department of Hand Surgery,the Second Hospital of Tangshan.Nine males and six females were involved,with an average age of 49 years(range,41 to 69 years).There were twist injury in eight cases and crush injury in seven cases,with four cases of distal phalanx fracture.The defect dimensions after debridement ranged from 3.5 cm×1.8 cm to 4.6 cm×2.4 cm,and the dimension of the flaps ranged from 3.8 cm×2.1 cm to 5.0 cm×2.7 cm.All defects were repaired using homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve.The survival,appearance and sensory recovery of the flaps and function of the injured fingers were observed at the follow-up after operation.Results All the flaps survived without wound infection and blood supply disorder.The follow-up times ranged from 9 to 22 months(mean,16 months).There was satisfactory appearance of the flaps with similar color and texture to the surrounding tissue.Fracture healing ranged from 4 to 6 weeks.At final follow-up,the values of static 2-PD test of the flaps ranged from 5 to 10 mm(mean,7.8 mm).The results of range of motion of injured thumb joints were excellent in nine cases and good in five cases.There was slight linear scar left at the donor area of dorsal thumb.Conclusions The innervated reversed dorsal digital artery island flap has a simple procedure and minimal donor-site cost,which is especially suitable for elderly patients who refuse to free toe transfers.

关 键 词：拇指 脱套伤 指背动脉皮瓣 末节缺损 创面修复 

分 类 号：R658.2[医药卫生—外科学]