摘要
目的 探讨改良第一掌背动脉岛状皮瓣修复拇指远端软组织缺损的成活优良率和感觉重建的疗效.方法 2004年3月至2007年10月,应用第一掌背动脉（the first dorsal metacarpal artery,FDMCA）皮瓣修复拇指近（末）节掌侧软组织缺损65例,获得完整随访资料者49例.男37例,女12例;年龄18～65岁,平均32岁.分别采用改良（31例）及常规筋膜蒂切取法（18例）治疗.改良方法与传统方法不同之处在于蒂部除包含FDMCA及该血管周围1 mm的肌袖外,还携带第一背侧骨间肌两肌腹间沟内的组织及宽1.5～2.0 cm的深筋膜及骨间肌肌膜为蒂.并将筋膜蒂中的神经束切断与拇指掌侧指神经残端以8-0线吻合.对两组皮瓣出现远端坏死、血管危象的频率及感觉恢复的差异进行统计学分析.结果 术后随访20个月～3年,平均2年.49块皮瓣中46块完全成活.用常规方法切取的皮瓣18例中5例术后出现血管危象,最终3块皮瓣远端部分坏死.31例改良FDMCA皮瓣成活良好,感觉恢复满意,且定位于拇指;18例神经转位皮瓣均有不同程度的混合感觉（33%）或异位感觉（62%）,仅1例皮瓣感觉完全定位于拇指.结论 改良筋膜蒂切取法的FDMCA皮瓣成活优良率明显提高.将皮瓣内携带的桡神经浅支与受区拇指掌侧指神经吻合可使皮瓣感觉定位于拇指,但尚不能证明其对皮瓣两点分辨觉及实体感觉恢复有明显影响.
Objective To explore the survival rate and early-term effects of sensory reconstruction of the modified first dorsal metacarpal artery （FDMCA） flap in treatment of thumb distal soft tissue defect.Methods From March 2004 to October 2007, 65 patients with soft tissue defects of the thumb underwent the FDMCA flap in our department. Forty-nine cases with complete data were included in the study. There were 37 males and 12 females, with an average age of 32 years （ranged, 18-65 years）. The conventional surgical methods were used in 18 cases while the improved surgical methods were in 31 cases. The distal necrosis, the vascular crisis rate and the sensory recovery were recorded. Results The mean follow-up period was 2 years （ranged, 20 months to 3 years）. Forty-six flaps survived completely. Vascular crisis occurred in five cases harvested by the conventional methods. Eventually, three of them had a partial distal necrosis.Improved FDMCA flap survived well in all 31 patients. Flaps in these patients with nerve anastomosis restored satisfied sense and all sense were located in the thumb. Eighteen cases of nerve transfer group had different levels of mixed feelings （33%） or ectopic sensory （62%）. Sense was located in the thumb completely in 1 case. Conclusion The modified FDMCA flap significantly increased the survival rate. Neurorrhaphy could make the sense of the flap locate in the thumb; however it had not been proved that its impact on the recovery of two-point discrimination and stereognosis.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第9期882-886,共5页
Chinese Journal of Orthopaedics
