摘要
目的探讨应用不同皮瓣修复手指中远节指腹皮肤缺损的临床疗效。方法设计3种手术方法修复患者中远节指腹皮肤缺损,共16例16指。其中包含指掌侧固有神经背侧支的手指侧方皮瓣修复6例,吻合神经血管趾腓侧趾背游离皮瓣显微修复6例,吻合神经血管尺动脉腕上皮支游离皮瓣显微修复4例。结果 1例患者皮瓣发生静脉危象,经探查血管后存活,其余15例均顺利一期存活。术后随访8～36个月,参照总主动活动度(TAM)测定法,患者手指功能分别为优10例、良5例、可1例。术后1年测定皮瓣感觉重建情况:包含指掌侧固有神经背侧支的手指侧方皮瓣的两点辨别觉平均(6.3±0.7)mm;吻合神经血管趾腓侧趾背游离皮瓣的两点辨别觉平均(5.8±1.1)mm;吻合神经血管尺动脉腕上皮支游离皮瓣的两点辨别觉平均(7.2±1.4)mm。结论包含指掌侧固有神经背侧支的手指侧方皮瓣修复的患者手指外形最好、两点辨别觉第二、功能最差;吻合神经血管趾腓侧趾背游离皮瓣显微修复的患者手指外形第二、两点辨别觉最好、功能最好;吻合神经血管尺动脉腕上皮支游离皮瓣显微修复的患者手指外形及两点辨别觉最差,功能同吻合神经血管趾腓侧趾背游离皮瓣显微修复的患者。
Objective To explore the therapeutic effect of 3 different kinds of flap reconstruction operations concerning repair of terminus finger and skin defects. Methods We adopted 3 different surgical approaches to repair 16 cases of finger and skin defects, among which 6 cases were treated with the neighboring lateral flap of anastomosing the palmar branch of a proper digital nerve （NPDN） to repair fingertip defects, 6 cases received surgeries with the lateral hallux dissociative neuruvascular flap（HDN）, and 4 cases were performed with the flap nourished by supra-wrist cutaneous branch of ulnar artery （ SPU ）. We utilized total activity measurement as the criteria to appraise the finger performance. Results Only one case suffered from post-operative venous crisis, but eventually survived by salvage operation. The remaining 15 cases were healed by first intention. The follow-up time was 8-36 months. In the total 16 cases, there were excellent in 10 cases, good in 5, medial in 1 according to total active motion method. The mean distance of two-point discrimination of NPDN group was 6.3 ± 0.7 mm, with the HDN of group 5.8 ± 1.1 mm and the SPU group of 7.2 ± 1.4 mm. Conclusions Concerning the repairation of terminus finger and skin defects, in terms of the distance of two-point discrimination, the HDN group was the best, the NPDN group was the second, and the SPU group was the worst; in terms of the appearance, the NPDN group was the best, the HDN group was the second, and the SPU group was the worst; in terms of the function, the HDN group was as wall as the SPU group, and the NPDN group was the worst.
出处
《中华移植杂志（电子版）》
CAS
2012年第4期8-10,共3页
Chinese Journal of Transplantation(Electronic Edition)
关键词
显微外科
软组织损伤
外科皮瓣
Microsurgery
Soft tissue injury
Surgical flap
