拇指桡背侧皮神经营养血管皮瓣瓦合邻指皮瓣修复拇指末节脱套样软组织缺损  

Repair of Degloving Defect of Distal Segment of Thumb with Dorsal Radius Neurocutaneous Vascular Flap of Thumb and Adjacent Finger Flap

作　　者：石定 刘宗义[1] 苟军全[1] 宋永斌 马芮 魏向丽 荣向科[1] SHI Ding;LIU Zongyi;GOU Junquan;SONG Yongbin;MA Rui;WEI Xiangli;RONG Xiangke(Department of Burn Plastic Microsurgery,the No.987 Hospital of PLA Joint Logistic Support Force,Baoji 721004,Shaanxi,China)

机构地区：[1]中国人民解放军联勤保障部队第九八七医院烧伤整形显微外科,陕西宝鸡721004

出　　处：《中国美容医学》2024年第1期11-14,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复拇指末节脱套样软组织缺损的临床治疗效果。方法:2017年10月-2021年2月,笔者医院对12例拇指末节脱套样软组织缺损患者采用拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复,创面面积2.0 cm×5.5 cm~3.5 cm×7.5 cm,门诊随访皮瓣外观与感觉、手功能及术后并发症情况。结果:拇指桡背侧皮神经营养血管皮瓣切取范围为2.0 cm×2.0 cm~3.5 cm×4.0 cm,示指近节背侧邻指皮瓣切取范围为1.5 cm×2.0 cm~3.0 cm×3.5 cm。术后随访6~18个月,平均9.4个月,11例拇指桡背侧皮神经营养血管皮瓣及10例邻指皮瓣成活良好,伤口甲级愈合。远期随访,10例拇指指腹饱满,外观满意,2例拇指指尖皮瓣萎缩。12例皮瓣供区均愈合良好,无明显瘢痕增生,功能恢复良好。12例拇指恢复良好的对捏及对掌功能,拇指指腹两点感觉辨别试验为7~16 mm,指背两点感觉辨别试验为6~11 mm。评定手功能:优8例,良2例,中2例。结论:拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复拇指末节脱套样软组织缺损,手术操作简便、安全,临床效果好,值得在基层医院推广。Objective To investigate the clinical effect of repairing degloving defect of distal segment of thumb with dorsal radius neurocutaneous vascular flap of thumb and adjacent finger flap.Methods From October 2017 to February 2021,the author's hospital used the dorsal radius neurocutaneous vascular flap of thumb and the adjacent finger flap of the index finger to repair 12 patients with degloving soft tissue defects of the distal thumb,the wound area was 2.0 cm×5.5 cm-3.5 cm×7.5 cm.The appearance and sensation of the skin flap,hand function and postoperative complications were followed up.Results The cutting range of dorsal radius neurocutaneous vascular flap of thumb was 2.0 cm×2.0 cm-3.5 cm×4.0 cm,and the adjacent finger flap of index finger was 1.5 cm×2.0 cm-3.0 cm×3.5 cm.The follow-up time was 6-18 months,with an average of 9.4 months.11 cases dorsal radius neurocutaneous vascular flap of thumb and 10 cases of adjacent finger flap survived well.In the long-term follow-up,10 cases had full thumb pulp and satisfactory appearance,and 2 cases had atrophy of thumb fingertip flap.The donor area of 12 flaps healed well,there was no obvious scar hyperplasia,and the function recovered well.The two-point sensory discrimination test of thumb abdomen was 7-16 mm and that of finger back was 6-11 mm.Hand function was evaluated:excellent in 8 cases,good in 2 cases and medium in 2 cases.Conclusion The repair of degloving soft tissue defects of the distal thumb with the dorsal radius neurocutaneous vascular flap of thumb and the adjacent finger flap of the index finger is simple and safe,and the clinical effect is good.It is worthy to be popularized in grass-roots hospitals.

关 键 词：拇指 脱套伤 软组织缺损 皮瓣 修复 

分 类 号：R622[医药卫生—整形外科]