两种指掌侧固有动脉背侧皮支皮瓣修复手指指端或指腹创面的比较  

Comparison of two types of flaps based on dorsal cutaneous branch of proper palmar digital artery for repair of wound of fingertip or finger-pulp

作　　者：王辉[1] 张一晗 王红涛 贾鑫玮 张雪[3] 贾松[1] 杨晓溪 WANG Hui;ZHANG Yihan;WANG Hongtao;JIA Xinwei;ZHANG Xue;JIA Song;YANG Xiaoxi(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan,Hebei Province 063000,China;Department of Orthopedics and Traumatology,the College of Traditional Chinese Medicine,North China University of Science and Technology,Tangshan,Hebei Province 063210,China;Office of Clinical Trial Institution,the Second Hospital of Tangshan,Tangshan,Hebei Province 063000,China)

机构地区：[1]唐山市第二医院手外科,河北唐山063000 [2]华北理工大学中医学院骨伤科,河北唐山063210 [3]唐山市第二医院临床试验机构办公室,河北唐山063000

出　　处：《中华显微外科杂志》2023年第3期278-283,共6页Chinese Journal of Microsurgery

基　　金：河北省医学科学研究计划项目(20201453);河北省医学适用技术跟踪项目(GZ2021030);唐山市科技计划项目(22150219J)。

摘　　要：目的比较指掌侧固有动脉背侧皮支螺旋桨皮瓣与血管链皮瓣修复手指指端或指腹创面的临床疗效。方法自2018年4月至2021年5月,对唐山市第二医院手外科急诊收治的55例55指第2~5指指端或指腹创面患者采用抽签法随机分为2组,采用指掌侧固有动脉背侧皮支螺旋桨皮瓣修复29例29指(螺旋桨组)和指掌侧固有动脉背侧皮支血管链皮瓣修复26例26指(血管链组),观察两组患者皮瓣及供区植皮成活情况。记录两组患者手术时间及随访时间,随访采用门诊复查、电话及微信视频相结合的方式,末次随访时记录两组患者皮瓣静态TPD、皮瓣及供区外观满意度及伤指关节活动度(ROM)。对两组计量资料行独立样本t检验,计数资料行χ^(2)检验或Fisher精确检验,P<0.05为差异有统计学意义。结果两组所有皮瓣及供区植皮均一期成活。螺旋桨组手术时间[(57.55±4.35)min]少于血管链组[(61.12±4.58)min],差异有统计学意义(P<0.05);螺旋桨组、血管链组随访时间分别为(14.55±2.89)个月和(15.15±3.78)个月,差异无统计学意义(P>0.05)。末次随访时,螺旋桨组患者皮瓣的静态TPD[(6.55±1.24)mm]及皮瓣外观满意度[(4.59±0.50)分],优于血管链组[TPD为(7.46±1.27)mm、满意度为(4.31±0.47)分],差异有统计学意义(P<0.05)。螺旋桨组、血管链组患者供区外观满意度及伤指ROM分别为(4.45±0.57)分、(190.86±8.56)°和(4.35±0.56)分、(185.96±10.58)°,两组比较差异无统计学意义(P>0.05)。结论指掌侧固有动脉背侧皮支螺旋桨皮瓣与血管链皮瓣均适用于修复手指指端或指腹创面;相比血管链皮瓣,螺旋桨皮瓣手术时间短,皮瓣感觉及外观更好。Objective To compare the clinical effectiveness of propeller flap and vascular chain flap based on dorsal cutaneous branch of proper palmar digital artery for repair of wounds of fingertip or finger-pulp.Methods From April 2018 to May 2021,a total of 55 patients(55 fingers)with wounds of fingertip or finger-pulp in the 2nd-5th fingers were treated in emergency surgery in the Department of Hand Surgery,the Second Hospital of Tangshan.The patients were randomly divided into 2 groups by the method of drawing lots.The wounds of 29 patients(29 fingers)were repaired by propeller flaps based on dorsal cutaneous branch of proper palmar digital artery(propeller group)and that of 26 patients(26 fingers)were treated by vascular chain flaps based on dorsal cutaneous branch of proper palmar digital artery(vascular chain group).Survival of the flaps and the skin grafts at donor sites were observed between the 2 groups.The operation and follow-up time in both groups were recorded.Postoperative follow-up included outpatient clinic visits,telephone reviews and WeChat video-clips.At final follow-up,the static TPD of the flaps,patient satisfaction with the appearance of flaps and donor sites and the Range of motion(ROM)of the injured fingers were recorded.The measurement and count data of both groups were compared by independent sample t-test,χ^(2)tests or Fisher's exact test,respectively.P<0.05 was considered a statistically significant.Results All the flaps and skin grafts survived primarily in both groups.The operation time in propeller group was 57.55 minutes±4.35 minutes.It was less than what in the vascular chain group(61.12 minutes±4.58 minutes)and with statistically significant difference(P<0.05).The follow-up period was 14.55 months±2.89 months in propeller group and 15.15 months±3.78 months in the vascular chain group.There was no significant difference between the 2 groups(P>0.05).At final follow-up,the static TPD and patient satisfaction with the appearance of flaps in propeller group were 6.55 mm±1.24 mm and 4.59

关 键 词：螺旋桨皮瓣 血管链皮瓣 背侧皮支 指掌侧固有动脉 指损伤 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]