游离携带不同神经的双侧第二趾侧方皮瓣修复同手二指缺损的疗效分析  

Therapeutic effect of bilateral second toe lateral flap with different nerves in repairing the defect of two fingers in the same hand

作　　者：吕文涛[1] 巨积辉[1] 徐磊[1] 侯绍鹏 李建宁[1] 葛成伟 蒋国栋[1] LYU Wentao;JU Jihui;XU Lei;HOU Shaopeng;LI Jianning;GE Chengwei;JIANG Guodong(Department of Hand Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,江苏苏州215104

出　　处：《中国美容整形外科杂志》2023年第7期388-390,395,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：苏州市民生科技项目(SS202092);姑苏卫生人才培养项目(GSWS2020116);苏州市临床重点病种诊疗技术专项项目(LCZX202026)。

摘　　要：目的探讨携带不同神经的双侧第2趾侧方皮瓣修复同手2指缺损的手术方法和临床疗效。方法自2014年2月至2020年11月,苏州大学附属瑞华医院手外科对31例伴有2指部分缺损的患者,分别采用吻合趾背神经(趾背组)与趾底神经(趾底组)的第2趾胫侧皮瓣进行移植修复。皮肤软组织缺损面积为2.2 cm×1.5 cm~1.8 cm×1.3 cm,皮瓣切取面积为2.5 cm×1.7 cm~2.0 cm×1.5 cm。皮瓣供区以全厚皮片植皮。术后对患者受区(患指外观满意程度、有无痛觉过敏、指端耐寒性、指端两点辨别觉、患指指间关节活动度)和供区(足趾活动度、植皮恢复、趾端感觉及对穿鞋行走有无影响)进行对比分析,并对受区皮瓣及供区趾腹两点辨别觉进行统计学分析。结果术后皮瓣及植皮全部成活。所有患者随访10~18个月,平均14个月,受区手指外观满意度、有无痛觉过敏、指端耐寒性方面无明显差异,指间关节活动受限程度差异无统计学意义,趾背组皮瓣两点辨别觉为(8.5±1.5)mm优于趾底组(9.5±1.5)mm(P<0.05)。供区足趾活动度、植皮恢复、穿鞋行走等差异无统计学意义,趾背组供趾胫侧趾腹感觉方面为(7.5±1.5)mm优于趾底组(10.5±1.5)mm(P<0.05)。结论在指端缺损修复中,切取趾背神经的第2趾胫侧皮瓣较切取趾底神经的第2趾胫侧皮瓣感觉恢复更好,并能减少供区损伤。Objective To compare the surgical method and clinical effect of bilateral second toe lateral flap with different nerves in repairing the fingertip defects of the same hand.Methods From February 2014 to November 2020,31 patients with partial defect of two fingers were transplanted with tibial lateral flap of the second toe,which was anastomosing with the dorsal nerve of the toe and the intrinsic nerve of the toe.The defect area of soft tissue was 2.2 cm×1.5 cm~1.8 cm×1.3 cm,and the flap area was 2.5 cm×1.7 cm~2.0 cm×1.5 cm.Full thickness skin graft was used in the donor area.The flap of bilateral foot donor area and finger recipient area were compared after the operation.The comparison includes the degree of satisfaction of the appearance of the affected finger,the presence of hyperalgesia,the cold resistance of the fingertip,the discrimination of the two points of the flap,the motion of the joint of the affected finger,the motion of the joint of the donor toe,the recovery of skin graft,the feeling of the toe tip and the influence on the walking with shoes.The statistical analysis was used to analyze the discrimination sense of the two points of the flap and the toe pulp of the donor area.Results All skin flaps and skin grafts survived.Followed up for 10 to 18 months,an average of 14 months.There was no significant difference in the satisfaction of the appearance of the fingers,whether there was hyperalgesia or not,and the cold tolerance of the fingers.In the objective indicators,restricted movement of the interphalangeal joint degree has no obvious difference.In the comparison of the two points of discrimination,the tibial flap group of the second toe anastomosed with the dorsal digital nerve was(8.5±1.5)mm,which was superior to the tibial flap group of the second toe anastomosed with the intrinsic nerve(9.5±1.5)mm(P<0.05).There was no obvious difference in the donor area in the degree of toe movement,skin graft recovery,and walking while wearing shoes.In terms of tibial toe pulp sensation,the dorsal digita

关 键 词：指端缺损 外科皮瓣 趾背神经 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]