摘要
目的为修复相邻两指指端软组织缺损提供一种新的术式。方法在手指近节指根部同时切取两块岛状皮瓣，修复7例相邻两指指端软组织缺损，其中利用一块皮瓣来修复同指，另一块皮瓣修复邻指。示、中指2例，中、环指4例，环、小指1例；手指末节指腹缺损8指，中节以远软组织缺损4指，手指残端缺损2指，均伴有肌腱、神经或指骨外露。切取指根部近侧皮瓣面积为1．2cm×1．5cm～2．3cm×1．5cm；远端皮瓣面积为1．0cm×1．0cm～1．5cm×1．0cm。结果术后7例14块皮瓣均顺利存活。1例患者术后6个月因勾甲畸形而再次行矫形术。术后6例随访时间为6～18个月，皮瓣血供及质地良好，两点分辨觉为8—12mm。根据中华医学会手外科学会上肢部分功能评定试用标准，手指功能恢复优良率为95．7％。结论本术式根据近节指动脉交通支的解剖特点，充分利用了手指近节的皮肤面积，在一块供区上切取两块皮瓣，减少了对另一指的外型及功能破坏，拓展了原有指根部岛状皮瓣的应用范围，为修复邻近两指的指端缺损提供了一种新思路。
Objective To introduce a new surgical procedure for repairing fingertip defects of two neighboring fingertips. Methods Seven cases of fingertip defects of two neighboring fingers were treated by transferring a proximal and a distal island flap harvested from the base of one of the involved fingers. The distal flap was transferred to repair defect of the same finger, while the proximal one was transferred to repair defect of the neighboring finger. There were defects of the index and middle fingers in 2 cases, defects of the middle and ring fingers in 4 eases, and defects of the ring and little fingers in 1 case. Finger pulp defect occurred in 8 digits, soft tissue defect distal to middle phalanx in 4 digits, and defect of finger stump in 2 cases. Exposure of the tendon, nerve or bone was seen in all cases. The size of the proximal flaps ranged from 1.2 cm × 1.5 cm to 2.3cm×1.5cm, while the size of distal flaps ranged from 1.0cm×1.0cm to 1.5cm×1.0cm. Results All 14 flaps in the 7 cases survived completely. One patient underwent secondary correction of crooked nail 6 months after the flap surgery. Postoperative follow-up ranged from 6 months to 18 months. All repaired fingers had satisfactory appearance and texture. Two-point discrimination was 8 to 12 mm. The good and excellent rate of finger function recovery was 95.7 % according to the provisional functional assessment criterion for upper limbs issued by the Chinese Hand Surgery Society. Conclusion The flap design of this procedure is based on the anatomical characteristics of communicating branches of the digital artery at the base of the finger. Two flaps from the base of the same finger are harvested to make full use of the harvestable area of the donor finger, and avoid damage to another finger. This procedure expands the applicable indications of finger base island flaps and is an ideal method to repair defects of neighboring fingers.
出处
《中华手外科杂志》
CSCD
北大核心
2010年第3期179-181,共3页
Chinese Journal of Hand Surgery
