带指掌侧固有神经背侧支的筋膜蒂岛状皮瓣修复指腹缺损  

Reconstruction of digital pulp defect with fascio-pedicled island flap carrying dorsal branch of proper palmar digital nerve

作　　者：张晓锐 周刚[1] 徐修磊 蔡继人 Zhang Xiaorui;Zhou Gang;Xu Xiulei;Cai Jiren(Department of Orthopaedics Zone 1,Shaw Hospital Affiliated,Zhejiang University School of Medicine,Alar Hospital,Xinjiang Production and Construction Corps,Alar 843300,China;Department of Orthopaedics Zone 2,Shaw Hospital Affiliated Zhejiang University School of Medicine,Alar Hospital,Xinjiang Production and Construction Corps,Alar 843300,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科一区,阿拉尔843300 [2]浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科二区,阿拉尔843300

出　　处：《中华显微外科杂志》2025年第1期50-54,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨带指掌侧固有神经背侧支筋膜蒂岛状皮瓣修复指腹缺损的手术方法及临床效果。方法回顾性分析2019年12月至2022年12月于浙江大学医学院附属邵逸夫医院新疆兵团阿拉尔医院骨科就诊的指腹缺损患者75例,其中男40例,女35例;年龄25~61岁,平均42岁;拇指23例,示、中、环指各15例,小指7例。指腹缺损范围0.8 cm×0.9 cm~1.5 cm×2.1 cm,皮瓣切取面积1.0 cm×1.2 cm~1.8 cm×2.4 cm。供区均为中厚皮片覆盖并加压包扎。术后通过门诊、微信及电话随访其临床效果。结果随访时间为9~15个月,平均12个月。切口及供区植皮均Ⅰ期愈合。术后73例皮瓣均完全成活;术后2例皮瓣出现部分坏死,经换药后愈合;4例皮瓣出现皮瓣青紫、肿胀,予拆除高张力缝线后解除;7例皮瓣出现张力性水疱,均在2周内消退。末次随访:皮瓣外观及质地54例优,21例良,无苍白、发绀及肤色灰暗皮瓣,皮瓣弹性正常或略显萎缩49例,轻度萎缩24例,中度萎缩2例,无明显萎缩皮瓣。57指患指活动度优(平均42.3°),12指良(平均26.7°),6指可(平均16.3°)。皮瓣区TPD 6~11 mm,平均8.1 mm。按照中华医学会手外科学会上肢部分功能评定试用标准进行评价,48指优(平均11.2分),22指良(平均8.1分),5指可(平均5.4分),优良率93.33%。所有皮瓣供区均无功能影响。患者满意53例,比较满意21例,不满意1例。结论应用带指掌侧固有神经背侧支筋膜蒂岛状皮瓣修复指腹缺损,成活率高,操作简单,效果满意,且不伤指体主干动脉,值得基层医院推广应用。Objective To investigate a surgical method and clinical outcomes of a fascia pedicled island flap with dorsal branch of proper palmar digital nerve in reconstruction of defects of digital pulp.MethodsSeventy-five patients who had digital pulp defects and treated at Department of Orthopaedics,Xinjiang Production and Construction Corps Alar Hospital,Shaw Hospital Affiliated Zhejiang University School of Medicine,from December 2019 to December 2022,were retrospectively analysed.The patients were 40 males and 35 females aged 25-61 years with an average age of 42 years.The defects of digital pulp involved in 23 thumbs,15 per group of index fingers,middle fingers and ring fingers,and 7 little fingers.The digital pulp defects were 0.8 cm×0.9 cm to 1.5 cm×2.1 cm in size,and the sizes of flap were 1.0 cm×1.2 cm to 1.8 cm×2.4 cm.Donor sites were covered by medium-thickness skin grafts and pressurised bandage was applied.Clinical outcomes of the surgery were monitored through the postoperative follow-ups at outpatient clinic,WeChat and telephone reviews.ResultsPostoperative follow-up ranged 9 to 15 months,with an average of 12 months.The donor sites and skin grafts all achieved stage-I healing.Seventy-three flaps completely survived after surgery.However,2 flaps had partial necrosis,which healed after dressing changes,4 flaps encountered flap bruising and swelling,which were rectified by removal of high-tension sutures,and 7 flaps had tension blisters,which had disappeared in 2 weeks.At the final follow-up,the appearance and texture of the flaps were graded as excellent for 54 flaps and good for 21 flaps,all without pale,cyanotic or dark in colour.Forty-nine flaps showed normal elasticity or with slight atrophy,24 with mild atrophy,2 with moderate atrophy and none with obvious or severe atrophy.Mobility of the affected digits was rated as excellent for 57 digits(average 42.3°),good for 12(average 26.7°)and fair in 6 digits(average 16.3°).TPD of flap surfaces ranged 6 to 11 mm,with an average of 8.1 mm.Digital functio

关 键 词：指掌侧固有神经背侧支 筋膜蒂 岛状皮瓣 指腹缺损 修复 

分 类 号：R658.3[医药卫生—外科学]