双层人工真皮移植与拇指桡背侧岛状皮瓣转移修复拇指末节缺损的疗效比较  

Comparison of clinical efficacy between double-layer artificial dermis transplantation and transfer of radial dorsal thumb island flap for repairing distal segment defects of the thumb

作　　者：李一[1] 李学渊[1] 俞淼 周映玲[1] 陆陈林 王晓峰[1] Li Yi;Li Xueyuan;Yu Miao;Zhou Yingling;Lu Chenlin;Wang Xiaofeng(Department of Hand Surgery,Ningbo Sixth Hospital,Ningbo 315040,China)

机构地区：[1]宁波市第六医院手外科,宁波315040

出　　处：《中华手外科杂志》2023年第4期289-293,共5页Chinese Journal of Hand Surgery

基　　金：宁波市重大科技任务攻关项目(2022Z146)。

摘　　要：目的回顾性分析双层人工真皮移植与拇指桡背侧岛状皮瓣转移修复拇指末节缺损的临床疗效。方法回顾性分析我科自2019年10月至2021年11月收治的拇指末节皮肤缺损骨外露患者共51例,应用双层人工真皮移植修复36例,拇指桡背侧岛状皮瓣修复15例。术后随访对比患者创面的愈合情况及时间,耐磨度,指腹感觉,两点分辨觉,手术时间,住院时间,总体住院费用。结果术后所有患者创口均愈合,随访时间为6~12个月,无创口感染,其中双层人工真皮移植组愈合后创面质地韧、耐磨,无瘢痕增生,无溃疡,外观较满意,指腹感觉评定均达到S3+,两点分辨觉为3.7~5.8 mm,平均(4.62±0.45) mm,平均手术时间为(43.33±4.37) min,平均住院天数为(4.47±1.83) d,平均住院费用为(9 508.94±1489.18)元,平均创面愈合时间为(38.89±4.86) d,而拇指桡背侧岛状皮瓣转移组创面愈合后皮瓣色红,质地柔软,外观较臃肿,耐磨性良好,皮瓣周围无明显瘢痕增生,2例患者皮瓣供区瘢痕增生较明显,皮瓣指腹感觉评定均达到S3+,两点分辨觉2.8~4.1 mm,平均(3.42±0.35) mm,平均手术时间为(77.47±7.08) min,平均住院天数为(14.33±4.39) d,平均住院费用为(17 717.89±4 270.80)元,平均创面愈合时间为(25.67±3.98) d。结论双层人工真皮移植修复拇指末节缺损手术简便,疗效满意,不损伤供区,同时节省治疗费用,值得进一步推广。Objective To analyze the clinical efficacy of double-layer artificial dermis transplantation and transfer of radial dorsal thumb island flap for repairing distal segment defects of the thumb.Methods A retrospective analysis was conducted on 51 patients with thumb distal skin defect and bone exposure admitted to our department from October 2019 to November 2021.Among them,36 cases were repaired with double-layer artificial dermis transplantation,and 15 cases were repaired with radial dorsal thumb island flap.The patients′wound healing situation and time,wear resistance,finger pulp sensation,two-point discrimination,operation time,hospital stay,and overall hospitalization cost were followed up and compared after surgery.Results All patients′wounds healed after surgery,with a follow-up time of 6 to 12 months and no wound infection.Among them,the double layer artificial dermis transplantation group had a tough and wear-resistant wound surface,no scar hyperplasia,no ulcer,and a satisfactory appearance after healing.The sensory evaluation of the finger pulp reached S3+.The two-point discrimination ranged from 3.7 to 5.8 mm with an average of(4.62±0.45)mm.The average operation time was(43.33±4.37)minutes,and average hospital stay was(4.47±1.83)days.The average hospitalization cost was(9508.94±1489.18)yuan,and the average wound healing time was(38.89±4.86)days.After the wound healing of the thumb radial dorsal island flap transfer group,the flap was red in color,soft in texture,bulky in appearance,and had good wear resistance.There was no obvious scar hyperplasia around the flap.About 2 patients had obvious scar hyperplasia in the flap donor area,and all flaps had a sensory evaluation of S3+.The two-point discrimination was 2.8 to 4.1 mm,with an average of(3.42±0.35)mm.The average operation time was(77.47±7.08)minutes,and the average hospital stay was(14.33±4.39)days.The average hospitalization cost was(17717.89±4270.80)yuan,and the average wound healing time was(25.67±3.98)days.Conclusion The double layer

关 键 词：拇指 治疗结果 末节缺损 人工真皮 岛状皮瓣 

分 类 号：R687.3[医药卫生—骨科学]