不同供区带神经同指指动脉背侧支侧方血管链皮瓣修复指端或指腹缺损效果比较  

Effect comparison of lateral vascular chain flaps with dorsal branches of nerve and digital artery in different donor sites for repairing finger tip or finger abdomen defects

作　　者：王红涛 王辉[1] 张一晗 贾鑫玮 WANG Hongtao;WANG Hui;ZHANG Yihan;JIA Xinwei(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan 063000,China)

机构地区：[1]唐山市第二医院手外科,河北唐山063000

出　　处：《实用医学杂志》2023年第20期2638-2642,共5页The Journal of Practical Medicine

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

摘　　要：目的探讨不同供区带神经同指指动脉背侧支侧方血管链皮瓣修复指端或指腹缺损临床效果。方法选取2017年6月至2021年4月,唐山市第二医院急诊采用指动脉背侧支侧方血管链皮瓣修复第2-5指端或指腹缺损患者49例(57指),进行前瞻性研究。采用抽签法分为近节背侧组23例(25指),其中男13例,女10例,年龄18~55岁,平均37岁,中节背侧组26例(32指),其中男15例,女11例,年龄20~53岁,平均35岁。术中两组均将皮瓣携带的皮神经与创面内指固有神经残端行端端外膜吻合。两组患者供区创面取前臂近端或上臂内侧全厚皮片游离植皮修复。术后观察两组患者皮瓣及植皮成活情况。比较两组术式的性别、年龄、伤指数、侧别、缺损面积、皮瓣切取面积、手术时间、随访时间。末次随访时,测量两组患者伤指掌指关节和近指间关节活动度情况,参照Michigan手部功能问卷评定标准评估患者对伤指皮瓣外观满意度,供区外观采用温哥华瘢痕量表评定,测量皮瓣静态两点辨别觉。结果术后两组皮瓣及植皮全部成活。两组在性别、年龄、伤指数、侧别、缺损面积、手术时间、随访时间比较,差异无统计学意义(P>0.05),在皮瓣切取面积方面差异有统计学意义(P<0.05)。末次随访时,中节背侧组与近节背侧组伤指掌指关节活动度和近指间关节活动度之和比较差异无统计学意义(P>0.05)。中节背侧组患者伤指皮瓣外观满意度、供区外观及皮瓣静态两点辨别觉显著优于近节背侧组(P<0.05)。结论以近或中节背侧为供区的指动脉背侧支侧方血管链皮瓣解剖恒定,操作简便,适用于急诊修复手指指端或指腹缺损,但与近节背侧组相比,中节背侧组患者皮瓣切取面积较小、伤指外观及皮瓣感觉更好。Objective To investigate the clinical effect of lateral vascular chain flaps with dorsal branches of nerve and digital artery in different donor sites in the repair of finger tip or finger abdomen defects.Methods From June 2017 to April 2021.Forty-nine patients(57 fingers)with the defect of the 2nd to 5th finger end or finger abdomen were repaired with the lateral vessel chain flap of the dorsal branch of digital artery in the emergency department of Tangshan Second Hospital.A prospective research was conducted.The patients were divided into dorsal proximal segment group[23 cases,25 fingers,including 13 males and 10 females,with mean age of 37 years(18-55 years)]and dorsal middle segment group[26 patients,32 fingers,including 15 males and 11 females,with mean age of 35 years(20-53 years)].Intraoperative end-to-end adventitia anastomosis was performed between the cutaneous nerve carried by the flap and the stump of the intrinsic digital nerve in the wound in both groups.The donor site wounds of patients in the two groups were repaired with free full-thickness skin grafts from the proximal forearm or medial upper arm.The blood supply of flaps in the two groups was observed after operation.Sex,age,injury index,side,defect area,flap area,operation time and follow-up time were compared between the two groups.At the last follow-up,static two-point distance perception of the flap was measured.Satisfaction with the appearance of the affected finger flap was evaluated according to Michigan Hand Function Questionnaire.Vancouver Scar Scale was used to evaluate the appearance of the donor site,and the range of motion of metacarpophalangeal and proximal interphalangeal joints were measured.The data were analyzed by using t test or χ^(2) test.Results All flaps and skin grafts survived after operation.No significant differences were found in sex,age,injury index,side,defect area,operation time and follow-up time between the two groups(P>0.05),but there was statistical significance in the area of the flap(P<0.05).At the last fo

关 键 词：外科皮瓣 指损伤 指端缺损 指腹缺损 指动脉背侧支 神经吻合 

分 类 号：R658[医药卫生—外科学]