摘要
目的观察指动脉逆行岛状皮瓣修复指腹缺损术后患指活动受限的发生率并分析其相关影响因素。方法对我院自2021年1月至2023年1月行指动脉逆行岛状皮瓣重建指腹的患者107例(114指)资料进行回顾性分析,对患者的性别、年龄、指别、损伤原因、蒂部切口设计、指腹缺损位置、皮瓣面积、供区植皮的形状及位置、瘢痕激光治疗的时机、康复治疗的时机与周期等12个因素进行分析,分析影响术后患指活动受限的相关因素。结果107例患者术后6个月至1年获得功能随访,其中40指发生术后活动受限,发生率达35.1%。单因素Logistic回归分析结果显示术后患指活动受限与患者的性别、年龄、受伤原因、缺损位置无关(P>0.05),而与蒂部切口(P=0.030)、皮瓣面积(P<0.001)、植皮形状(P=0.008)、植皮位置(P=0.044)、激光治疗(P<0.001)、康复治疗时机(P=0.003)及康复治疗周期(P=0.001)相关。多因素Logistic回归分析发现皮瓣面积大小是影响术后患指活动受限的独立危险因素(OR=3.045;95%Cl:1.578~5.875;P=0.001),不利于患指活动功能恢复;术后早期激光治疗(OR=0.017;95%Cl:0.003~0.102;P<0.001)和早期康复治疗(OR=0.139;95%Cl:0.026~0.754;P=0.022)是影响术后患指活动受限的独立保护因素。结论早期瘢痕激光及康复治疗可显著降低指动脉逆行岛状皮瓣重建指腹患者术后患指活动受限的发生率;皮瓣面积较大是患指术后活动受限的独立危险因素,临床中对于这类患者可考虑其他术式修复缺损,以减少术后活动受限发生率。
Objective To observe the incidence of restricted finger movement after the repair of finger pulp defects with reverse digital artery island flap and analyze its related influencing factors.Methods A retrospective analysis was conducted on the data of 107 patients(114 fingers)who underwent reverse digital artery island flap reconstruction of the fingertips in our hospital from January 2021 to January 2023.Twelve factors,including gender,age,finger type,cause of injury,design of pedicle incision,location of fingertip defect,flap area,shape and position of skin graft in the donor area,timing of scar laser treatment,timing and cycle of rehabilitation treatment,were analyzed.The relevant factors that affect postoperative finger mobility limitation were analyzed.Results All the 107 patients received functional follow-up from 6 months to 1 year after surgery,of which 40 fingers experienced postoperative mobility restriction,with an incidence rate of 35.1%.The results of univariate logistic regression analysis showed that postoperative finger mobility restriction was not related to the patient′s gender,age,cause of injury,defect location(P>0.05),but was related to the pedicle incision(P=0.030),flap area(P<0.001),graft shape(P=0.008),graft location(P=0.044),laser treatment(P<0.001),rehabilitation treatment timing(P=0.003),and rehabilitation treatment cycle(P=0.001).Multivariate logistic regression analysis found that the size of the skin flap was an independent risk factor for postoperative limited finger mobility(OR=3.045;95%Cl:1.578 to 5.875;P=0.001),which was not conducive to the recovery of finger mobility function.The early postoperative laser therapy(OR=0.017;95%Cl:0.003 to 0.102;P<0.001)and early rehabilitation therapy(OR=0.139;95%Cl:0.026 to 0.754;P=0.022)are independent protective factors affecting postoperative finger mobility limitation.Conclusion The early scar laser and rehabilitation therapy can significantly reduce the incidence of postoperative restricted finger movement in patients undergoing digital ar
作者
柳晨
施海峰
赵刚
宋骁军
吴柯
沈泳
张志海
沙一帆
徐鹏
庞新岗
Liu Chen;Shi Haifeng;Zhao Gang;Song Xiaojun;Wu Ke;Shen Yong;Zhang Zhihai;Sha Yifan;Xu Peng;Pang Xingang(Department of Hand Surgery,Wuxi 9th People′s Hospital Affiliated to Suzhou University,Wuxi 214062,China)
出处
《中华手外科杂志》
CSCD
北大核心
2024年第1期14-20,共7页
Chinese Journal of Hand Surgery
基金
2022年"滨湖之光"人才计划([2022]5)。
关键词
外科皮瓣
指损伤
活动受限
影响因素
Surgical flaps
Finger injuries
Movement limitation
Influencing factors
