摘要
目的探讨应用--种改良传统局部转移皮瓣术修复手指尖部缺损的手术方法以及临床治疗效果。方法自2017年1月至2019年6月,我们对78例(78指)手指尖皮肤缺损的患者分别采用改良局部转移皮瓣术(A组)和V-Y皮瓣术(B组)治疗,其中A组39例、B组39例。术后记录手术时间、两点分辨觉(two-point discrimination,2-PD);采用手指总主动活动度(total active movement,TAM)和密歇根手部问卷(Michigan Hand Questionnaire,MHQ)评价治疗效果。结果术后两组患者78指全部存活,随访时间为6~12个月,A组平均(8.1±1.2)个月,B组平均(7.3±0.9)个月。A组手术时间为(31.2±4.8)h与B组为(35.8±5.7)h,两组差异无统计学意义(P>0.05)。末次随访时,两组患者手指皮瓣2-PD及TAM结果比较差异均无统计学意义(P>0.05)。A组的MHQ为(95.19±3.14)分高于B组(89.73±3.41)分,差异有统计学意义(P<0.05)。MHQ子量表结果显示,两组的整体手功能、日常生活活动.工作表现和疼痛评分差异无统计学意义(P>0.05),但A组的美学评分(93.45±7.16)分及满意度(93.15±5.61)分均高于B组的(87.76±5.60)分和(87.52±4.21)分,差异有统计学意义(P<0.05)。结论改良传统局部转移皮瓣术可有效治疗手指尖皮肤缺损,术后瘢痕小,操作简单,并且可获得更大的推移距离。
Objective To explore the surgical method and clinical efficacy of a modified local transfer flap in repairing fingertip defects.Methods From January 2017 to June 2019,78 patients(78 fingers)with fingertip defects were treated with modified local transfer flap(groupA)and V-Y flap(group B),including 39 cases in group A and 39 cases in group B.The operation time and two-point discrimination(2-PD)were recorded after operation.The total active movement(TAM)and Michigan Hand Questionnaire(MHQ)were used to evaluate the treatment effect.Results All the 78 fingers of patients in the two groups survived uneventfully after operation.The follow-up time was6 to 12 months,with an average of(8.1±1.2)months for group A and(7.3±0.9)months for group B.The operation time was(31.2±4.8)hours in group A and.(35.8±5.7)hours in group B.There was no significant difference between the two groups(P>0.05).At the last follow-up,there was no significant difference in the results of 2-PD of finger flap and TAM between the two groups(P>0.05).The MHQ of group A was(95.19±3.14)points,which was higher than that of group B(89.73±3.41)points,and the difference was statistically significant(P<0.05).The results of MHQ sub scale showed that there was no significant difference in the overall hand function,activities of daily living,work performance and pain scores between the two groups(P>0.05),but the aesthetic score(93.45±7.16)points and satisfaction score(93.15±5.61)points of group A were higher than those of group B(87.76±5.60)points and(87.52±4.21)points,and the difference was statistically significant(P<0.05).Conclusion The modified traditional local transfer flap can effectively treat the skin defects of fingertip,with small scar,simple operation,and larger moving distance.
作者
张瑛凯
吴荣博
王耀
周嘉琦
Zhang Yingkai;Wu Rongbo;Wang Yao;Zhou Jiaqi(Department of Orthopedics,Jinshan Hospital Affiliated to Fudan University,Shanghai 201508,China)
出处
《中华手外科杂志》
CSCD
北大核心
2023年第1期26-29,共4页
Chinese Journal of Hand Surgery
基金
金山区第六周期重点学科建设(JSZK2019B01)
复旦大学附属金山医院青年基金项目(JYQN-LC202107)。
关键词
指损伤
外科皮瓣
指尖缺损
Finger injuries
Surgical flaps
Fingertip defects
