摘要
目的研究应用指骨下筋膜瓣联合甲模板修复甲床缺损的方法可行性及临床疗效。方法自2019年6月至2022年12月我科急诊收治15例甲床缺损患者,均伴有指骨骨质外露,甲床缺损为原面积的1/4~2/3,彻底清创后采用患指远端指骨下筋膜瓣覆盖骨外露创面,使用5-0可吸收缝线缝合筋膜瓣和残留甲床创缘,使用莫非氏管修剪制作甲模板覆盖于甲床和筋膜瓣之上,缝线稍加压固定甲模板,待自然脱落甲模板。术后随访观察创面愈合情况和指甲生长情况,按照李宝山等指甲评价标准评价患处恢复情况。结果本组15例15指筋膜瓣全部存活良好,创口Ⅰ期愈合,供区无坏死。术后随访2~12个月,平均5.6个月。指甲生长良好,平整光滑,指甲和筋膜瓣贴合完好,指腹供区无瘢痕,指腹饱满,手指活动正常,无压痛。按照指甲评定标准:优12例,良2例,差1例。其中1例差因为随访时间短指甲未能生长良好。结论应用指骨下筋膜瓣联合甲模板修复指骨骨质外露、甲床缺损,具有操作简便、损伤较小且指甲外形恢复良好等优点,是急诊处理甲床缺损的较好选择。
Objective To study the feasibility and clinical efficacy of subphalangeal fascia flap combined with nail template for repair of nail bed defects.Methods From June 2019 to December 2022,15 patients with nail bed defects were admitted to our department for emergency treatment.All the patients have nail bed defects accounting for 1/4 to 2/3 of the original area combined with phalangeal bone exposure.After thorough debridement,the distal phalanx fascial flap of the affected finger was used to cover the bone exposed wound,and 5-0 absorbable sutures were used to suture the fascia flap and residual nail bed wound margins.Moffey′s tube was used to trim and make the nail template to cover the nail bed and fascia flap,and the suture was slightly pressurized to fix the nail template.The nail template would peel off naturally.The wound healing and nail growth were followed up after surgery,and the recovery of the affected area was evaluated according to the nail evaluation standards issued by Li Baoshan et al.Results All 15 cases of 15 fingers in this group survived well,with primary wound healing and no necrosis in the donor area.The postoperative follow-up ranged from 2 to 12 months,with an average of 5.6 months.The nails grow well,flat and smooth,with a good fit between the nails and fascia flaps.The donor area of the finger pulp is free of scars,the finger pulp is full,the finger movement is normal,and there is no tenderness.According to the nail evaluation criteria,the results were excellent in 12 cases,good in 2 cases,and poor in 1 case.One of them had poor nail growth due to a short follow-up time.Conclusion The application of subphalangeal fascia flap combined with nail template to repair bone exposure and nail bed defects of the phalanges has the advantages of simple operation,minimal damage,and good nail shape recovery.It is a good choice for emergency treatment of nail bed defects.
作者
马明明
何威
李勇
宁涛
Ma Mingming;He Wei;Li Yong;Ning Tao(Department of Hand Surgery,Fuyang People′s Hospital,Fuyang 236000,China)
出处
《中华手外科杂志》
CSCD
北大核心
2023年第4期337-340,共4页
Chinese Journal of Hand Surgery
基金
蚌埠医学院附属阜阳市人民医院重点项目(2020byzd347)
阜阳市卫健委课题(FY2021-027)
安徽医科大学课题(2022xkj225)。
关键词
指损伤
治疗结果
筋膜瓣
甲模板
甲床缺损
Finger injuries
Treatment outcome
Fascia flap
Nail template
Nail bed defect