摘要
目的探讨应用V-U形皮瓣修复指尖软组织缺损的方法及疗效。方法 2006年1月-2011年2月,收治47例(55指)指尖软组织缺损患者。男25例,女22例;年龄18～35岁,平均26岁。致伤原因:切割伤21例,撕脱伤26例。受伤至入院时间1～6 h,平均2.6 h。损伤指别:拇指18指,示指10指,中指10指,环指9指,小指8指。41指远端指间关节处皮肤撕脱致末节指骨完全或部分外露;14指远端指节缺损,第2指节指骨部分或全部外露。创面范围为1.1 cm×1.0 cm～1.9 cm×1.7 cm。伤后至一期手术时间2～7 h,平均5 h。一期手术采用带蒂皮瓣修复残端;于一期术后3周行二期手术,将带蒂皮瓣制备成1个U形、2个V形皮瓣,形成末节指节被盖皮瓣修复创面。结果 5指二期术后2 d内出现皮瓣瘀紫和水疱,对症处理后成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。一期术后供区均Ⅰ期愈合。二期术后42例(50指)获随访,随访时间6～12个月,平均8.9个月。皮瓣外形平整、质地柔软、弹性好,颜色与受区皮肤相似。伤指有触觉及痛温觉,皮瓣两点辨别觉为5～8 mm。末次随访时,手指功能根据中华医学会手外科学会修订的上肢部分功能评定标准:获优46指,良4指。结论应用V-U形皮瓣修复指尖软组织缺损,手指外观及功能恢复良好,是理想的修复方法之一。
Objective To investigate the method and effectiveness of V-U-shaped flaps in repairing soft tissue defect of the fingertip.Methods Between January 2006 and February 2011,47 patients（55 fingers） with soft tissue defect of fingertip were treated by using the V-U-shaped flaps.There were 25 males and 22 females,aged 18 to 35 years（mean,26 years）.The injury was caused by cuts in 21 cases and avulsion in 26 cases.The time between injury and admission was 1 to 6 hours with an average of 2.6 hours.The injured fingers included thumb（18 fingers）,index finger（10 fingers）,middle finger（10 fingers）,ring finger（9 fingers）,and little finger（8 fingers）.Forty-one fingers had skin avulsion of the distal interphalangeal joint with phalanx exposure,and 14 fingers had distal dactylopodite defect and second phalanx exposure.The size of wound ranged from 1.1 cm × 1.0 cm to 1.9 cm × 1.7 cm.The time between injury and first-stage operation was 2 to 7 hours with an average of 5 hours.In the first-stage operation,the pedicled flap was used to repair the defect of dactylopodite.Then at 3 weeks after the first-stage operation,one U-shaped flap and two V-shaped flaps were prepared to cover defect of the fingertips in the second-stage operation.Results At 2 days after the second-stage operation,congestion and blisters occurred in 5 fingers,and were improved after symptomatic treatment.The other flaps survived,and wounds healed by first intention.Incisions at the donor site healed primarily.After the second-stage operation,42 cases（50 fingers） were followed up 6 to 12 months（mean,8.9 months）.The appearance,texture,and color of the flaps were similar to normal skin.Injured fingers had tactile,pain,and thalposis,and the two point discrimination was 5-8 mm.At last follow-up,according to the functional assessment standards by the Chinese Medical Association Society of Hand Surgery of the upper limbs,the results were excellent in 46 fingers and good in 4 fingers.Conclusion V-U-shaped flaps can be considered as an ideal method to repair soft tissue defect of the fingertip because of good appearance and function recovery.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第12期1462-1464,共3页
Chinese Journal of Reparative and Reconstructive Surgery
