V-Y推进皮瓣并甲床直接缝合修复AllenⅢ型指尖离断16例  

Fingertip reconstruction with V-Y advancement flap and nailbed suture following Allen’s typeⅢamputation:a report of 16 cases

作　　者：陆一鸣 王斌[1,2] 王天亮 王洋[1,2] 顾加祥 张乃臣 Lu Yiming;Wang Bin;Wang Tianliang;Wang Yang;Gu Jiaxiang;Zhang Naichen(Department of Foot and Hand Surgery,Northern Jiangsu People’s Hospital,Yangzhou 225001,China;Clinical Medical College,Yangzhou University,Yangzhou 225009,China)

机构地区：[1]江苏省苏北人民医院手足外科,扬州225001 [2]扬州大学临床医学院,扬州225009

出　　处：《中华整形外科杂志》2023年第8期868-872,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨V-Y推进皮瓣并甲床直接缝合修复无法行血管吻合的AllenⅢ型指尖离断的效果。方法回顾性分析2018年9月至2020年12月江苏省苏北人民医院收治的AllenⅢ型指尖离断患者资料,采用V-Y推进皮瓣并甲床直接缝合修复损伤。术中显微镜下探查见无血管吻合条件,复位末节指骨后以1枚克氏针固定。尽可能拉平甲床后缝合,如若残留间隙,待血痂形成自行生长。根据有无甲板决定是否采用人造甲板覆盖。剔除离断指体掌侧软组织,保留骨膜、甲下皮后,切取V-Y皮瓣达皮下脂肪球,向前推进与甲下皮缝合修复软组织缺损。术后常规采用抗感染治疗,不使用烤灯保温,湿润烧伤膏涂抹保湿。术后观察患指指甲平整度、指腹饱满度,调查患者对外形的满意度,测量两点辨距觉和远指间关节主动屈伸丢失角度。采用中华医学会上肢部分功能评定试用标准评价患指功能。结果共纳入16例患者(18指),男9例,女7例;年龄(31.5±6.1)岁(21~52岁);单指损伤14例,多指损伤2例;损伤指别:拇指2指,示指3指,中指6指,环指5指,小指2指。术后指尖离断体均存活,1例(1指)感染致末节指端轻度骨外露,再次手术治疗后愈合良好,1例(1指)轻度钩甲,余患者对外形均可接受或满意。随访7~16个月(中位时间12个月),患者全部达到骨愈合,背侧指甲均平整生长,指腹饱满。末次随访时患指指尖两点辨距觉为2.5~4.6 mm,平均3.8 mm;患指远指间关节主动屈曲丢失角度为0°~3.6°,平均2.4°,主动伸直丢失角度为2.0°~12.0°,平均7.6°。患指功能评价:优11例,良3例,可2例。结论V-Y推进皮瓣并甲床直接缝合修复无法行血管吻合的AllenⅢ型指尖离断,可以较好地保留指尖长度及指甲外形,保留饱满以及感觉良好的指腹,修复成功率高,操作简单,术后外观满意,功能较好。Objective To discuss the effect of fingertip reconstruction with V-Y advancement flap and nailbed suture treating Allen’s typeⅢamputations unsuitable for vascular anastomosis.Methods From September 2018 to December 2020,clinical data of patients with Allen’s typeⅢfingertip amputations treated in Northern Jiangsu People’s Hospital were analyzed retrospectively.The fingertips were reconstructed with V-Y advancement flap and nailbed suture.The infeasibility of vascular anastomosis was checked under the microscope.Following fixation of the distal phalanx,the nailbed was stretched as flat as possible and sutured.If the nail plate was missing,a manual nail plate made from a plastic transfusion pipe would be fixed to cover the exposed nailbed.The palmar soft tissue of the amputated fingertip was excised,and periosteum,hyponychium,nailbed,and dorsal soft tissue were retained.The proximal volar skin was incised until the subcutaneous adipose layer to get a V-Y advancement flap.The volar defect was repaired with the V-Y advancement flap distally sutured with the pre-retained hyponychium.Postoperatively,burn cream was smeared on the nail for moisturizing,without lamp heating,and intravenous antibiotics was administered routinely.The main indexes were collected including nail appearance,pulp plumpness,static two-point discrimination,motion loss of the distal interphalangeal joint,and patients’self-evaluation of the appearance.Chinese Medical Association trial standard of upper limb partial function assessment(CMA evaluation)was used to evaluate finger function.Results A total of 16 patients with 18 fingertips were included.There were 9 males and 7 females,aged(31.5±6.1)years(21-52 years).There were 14 cases of single fingertips injury and 2 cases of multiple fingertips injury.Damaged finger:2 of thumb,3 of indicator finger,6 of middle finger,5 of ring finger,2 of little finger.All 18 fingertips survived postoperatively and followed up for 7-16 months(median 12 months).One case underwent a second surgery due to i

关 键 词：指损伤 再植术 皮瓣 指甲 

分 类 号：R658.1[医药卫生—外科学]