以第1跖背动脉为蒂的趾侧分叶皮瓣修复相邻两指指腹缺损的临床效果  

Clinical efficacy of the first dorsal metatarsal artery pedicled lateral toe bilobed flap in repairing the finger pulp defects of two adjacent fingers

作　　者：李士民 周树萍 陈俊杰 李森 石英光 郑立武 常超楠 王焕朋 孙柯 尹大清 Li Shimin;Zhou Shuping;Chen Junjie;Li Sen;Shi Yingguang;Zheng Liwu;Chang Chaonan;Wang Huanpeng;Sun Ke;Yin Daqing(Department of Burns and Plastic Surgery,the 988th Hospital of Joint Logistics Support Force of PLA,Zhengzhou 450007,China)

机构地区：[1]解放军联勤保障部队第988医院烧伤整形科,郑州450007

出　　处：《中华烧伤与创面修复杂志》2025年第1期70-76,共7页Chinese Journal of Burns And Wounds

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20240983)。

摘　　要：目的探讨采用以第1跖背动脉为蒂的趾侧分叶皮瓣修复相邻两指指腹缺损的临床效果。方法该研究为回顾性观察性研究。2018年1月—2022年12月,解放军联勤保障部队第988医院烧伤整形科收治9例符合入选标准的相邻两指指腹缺损患者,其中男6例、女3例,年龄26~48岁。受伤手指为示指和中指者5例、中指和环指者4例。清创后单个手指创面面积为1.2 cm×0.8 cm~3.2 cm×2.8 cm,采用以第1跖背动脉为蒂的趾侧分叶皮瓣修复相邻两指指腹缺损并行两指并指缝合,单个皮瓣切取面积为1.5 cm×1.0 cm~3.5 cm×3.0 cm。将皮瓣供区创面直接缝合或取腹股沟区全厚皮修复。术后3周行分指手术。术后观察皮瓣成活情况、血运及供区皮片成活情况、创面愈合情况。随访时观察皮瓣的质地、滑动性、外形和手指活动功能,以及足部供区外形及功能。末次随访时,参考英国医学研究会感觉评定标准进行皮瓣感觉评定,参考中华医学会手外科学会断指再植功能评定试用标准进行手功能评定。结果9例患者术后皮瓣全部成活,无血管危象发生,皮瓣质地柔软、外形良好。1例患者足趾移植皮片边缘部分坏死,经换药后创面愈合;其余8例患者足趾移植皮片全部成活,创面愈合良好。术后随访12~18个月,皮瓣质地柔软、弹性好、滑动性小、外形良好;手指活动功能正常;足部供区创面恢复好,无破溃及畸形,行走无影响。末次随访时,皮瓣感觉灵敏,其中8指皮瓣感觉达S3级、10指皮瓣感觉达S3+级,皮瓣两点辨别觉距离为9~13 mm;患指功能评分为85~95分,均为优。结论以第1跖背动脉为蒂的趾侧分叶皮瓣可同时修复相邻两指指腹缺损,术后患指外形、感觉、功能恢复良好,且对足部供区损伤较小,是临床较佳的修复相邻两指指腹缺损的方法之一。Objective To explore the clinical efficacy of the first dorsal metatarsal artery pedicled lateral toe bilobed flap in repairing the finger pulp defects of two adjacent fingers.MethodsThis study was a retrospective observational study.From January 2018 to December 2022,9 patients with finger pulp defects in two adjacent fingers who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 988 th Hospital of Joint Logistics Support Force of PLA,including 6 males and 3 females,aged 26 to 48 years.The injured fingers were the index finger and middle finger(5 cases)or the middle finger and ring finger(4 cases).After debridement,the wound area of a single finger ranged from 1.2 cm×0.8 cm to 3.2 cm×2.8 cm.The finger pulp defects of two adjacent fingers were repaired with the first dorsal metatarsal artery pedicled lateral toe bilobed flap,and the two adjacent fingers were sutured together.The area of single flap ranged from 1.5 cm×1.0 cm to 3.5 cm×3.0 cm.The wound in the flap donor site was sutured directly or repaired with full-thickness skin graft from the groin region.The finger separation surgery was performed 3 weeks after surgery.The survival and blood supply of flaps,and survival of skin grafts and wound healing of the donor sites were observed after surgery.During follow-up,the texture,sliding,and shape of the flap,movement function of the finger,and the shape and function of the foot donor site were observed.At the last follow-up,the sensory of the flap was evaluated according to the sensory evaluation standard of the British Medical Research Council,and the hand function was evaluated according to the functional evaluation trial standard for severed finger replantation of the Hand Surgery Society of the Chinese Medical Association.ResultsAfter surgery,all the flaps of 9 patients survived without vascular crisis.The flaps were soft in texture and good in shape.One patient had partial necrosis at the edge of the skin graft in the toe,and the wound healed after dressing ch

关 键 词：指损伤 外科皮瓣 显微外科手术 修复外科手术 趾侧分叶皮瓣 创面修复 

分 类 号：R65[医药卫生—外科学]