摘要
目的探讨应用单皮下蒂V-Y推进皮瓣联合蒂部植皮修复指端缺损的手术方法及治疗效果。方法2013年8月至2020年12月,对25例25指指端软组织缺损的患者,创面缺损的面积达0.8 cm×0.8 cm~1.6 cm×1.4 cm,采用单皮下蒂V-Y推进皮瓣联合蒂部植皮的方式进行修复,皮瓣在创面的掌侧或侧方切取,皮瓣切取面积为0.5 cm×1.0 cm~0.8 cm×2.5 cm。为使皮瓣转移的距离更远,术中除了切断皮瓣的皮下纤维连接外,同时切断一侧皮下蒂,最终使皮瓣的推进距离达0.5~1.2 cm,皮瓣切取后,供区均切取腕横纹处中厚皮片植皮关闭。术后定期门诊、电话、微信或上门随访,观察患者皮瓣外观、感觉及手指关节功能恢复情况,同时调查患者满意度。结果术后25例25指皮瓣及供区植皮全部成活,伤口一期愈合,并获得4个月~8年随访。皮瓣及植皮区质地优良,指纹已经重建,外形饱满,TPD达4~9 mm,手指关节功能均恢复良好,未主诉供区感觉不适。按照Michigan手部功能问卷评定标准,25例患者对手部整体外观及功能非常满意。按照关节总活动度(TAM)评定标准,25例均为优。结论单皮下蒂V-Y推进皮瓣联合蒂部植皮修复指端缺损,皮瓣切取简单、创伤小,推进距离远,修复效果好,是修复指端缺损的一种理想的方法。
Objective To explore the surgical method and therapeutic effect of repairing soft tissue defect of digit-tip with single subcutaneous pedicle V-Y advancing flap combined with skin grafting.Methods From August 2013 to December 2020,25 soft tissue defects of digit-tip were repaired by a single subcutaneous pedicle V-Y advancing flap combined with pedicle skin grafting.The area of the defects was 0.8 cm×0.8 cm to 1.6 cm×1.4 cm.The flaps were harvested from palm or lateral side of the wound and the area of flap was 0.5 cm×1.0 cm to 0.8 cm×2.5 cm.In order to make the flap transfer to a further distance,the subcutaneous fibre connection of the flap was cut-off during the operation.At the same time,cut off 1 side of subcutaneous pedicle.Finally,the advanced distance of the flap reached 0.5-1.2 cm.After the flap harvested,the medium thickness skin was removed for graft to close the donor site from the wrist striations.After the surgery,follow-up visits were conducted regularly by outpatient clinic,or via telephone or WeChat review or by home visit.Throughout the follow-up,the flap appearance,sensation and recovery of the function of digital joint were observed,together with the patient satisfaction.Results After the surgery,the postoperative follow-up lasted for 4 months to 8 years.All 25 flaps and skin grafts were survived in first stage wound healing.The flaps and skin grafting areas had excellent texture.The fingerprint had been reconstructed with good appearance.The TPD was 4-9 mm,the functions of digital joint recovered well,and there was no complain about a discomfort at the donor site.According to the evaluation standard of Michigan hand function questionnaire,all 25 patients were very satisfied with the overall appearance and function of the hand.According to Total Angle of Motion(TAM)evaluation standard,finger mobility was excellent in all 25 patients.Conclusion Subcutaneous V-Y advancing flap combined with skin grafting is an ideal method for repairing soft tissue defect of digit-tip.The surgery characteris
作者
侯桥
富红梅
任国华
洪生虎
杨军
庄伟
曾林如
全仁夫
HOU Qiao;FU Hongmei;REN Guohua;HONG Shenghu;YANG Jun;ZHUANG Wei;ZENG Linru;QUAN Renfu(Department of Hand Surgery,Jiangnan Hospital Affiliated to Binjiang College,Zhejiang University of Traditional Chinese Medicine,Hangzhou 311200,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2022年第2期171-174,共4页
Chinese Journal of Microsurgery
关键词
皮下蒂皮瓣
指损伤
V-Y推进皮瓣
修复
Subcutaneous pedicle flap
Digit injury
V-Y advancing flap
Repair
