摘要
目的探讨携带感觉神经的拇指指背侧穿支皮瓣修复拇指皮肤软组织缺损的临厉i效果。方法自2010年9月至2014年6月，对20例20指拇指皮肤软组织缺损患者，缺损面积1．0cm×1．8cm-2．0cm×2．2cm，其中5例纵行缺损距离小于1．5cm的指背创面设计携带感觉神经的拇指背侧穿支V-Y推进皮瓣修复；11例拇指末节掌侧或者背侧皮肤软组织缺损的病例采用携带感觉神经的拇指背侧穿支逆行岛状皮瓣修复，供区直接缝合；4例拇指末节掌侧皮肤软组织缺损的病例采用携带感觉神经的拇指指背侧穿支逆行岛状皮瓣修复，供区无法直接缝合，采用拇指指背穿支蒂V-Y接力皮瓣修复供区创面；术中将逆行皮瓣内指背神经与一侧指神经或指背神经缝合重建皮瓣的感觉。结果20例20指术后获得随访，时间6-12个月，皮瓣全部顺利存活，蒂部无臃肿，质地柔软，外观满意，颜色与周围皮肤接近，两点分辨觉7-10mm，患指术后各关节活动正常。指背创面线形愈合，手功能采用手指关节总活动度（TAM）法评定：优16指，良3指，可1指；供区无并发症。结论该术式不损伤指动脉和指神经，优化了传统的指背筋膜岛状皮瓣手术，是修复拇指皮肤缺损的一种新型皮瓣。
Objective To investigate the therapeutic effect of including sensory nerves in the dorsal perforator flap of the thumb to cover skin defects. Methods From September 2010 to June 2014, 20 digits in 20 patients with skin defect of the thumb were treated. The defect area was 1.0 cm×1.8 cm to 2.0 cm×2.2 cm in size. Five cases with a defect less than 1.5 cm in the longitudinal dimension were treated with dorsal sensory nerve perforator V-Y advancement flap. Reverse perforator island flap including the thumb dorsal sensory nerve was transferred to cover distal volar or dorsal skin and soft tissue defect of the thumb in 11 cases. Donor sites were directly closed. For 4 cases of distal volar thumb skin defects the donor site of the dorsal sensory nerve reverse perforator island flap could not be directly sutured. A V-Y perforator flap from the dorsum of the thumb was advanced to cover the donor site wounds. The nerve included in the flap was sutured to the dorsal cutaneous nerve or one of the digital nerves to restore flap sensation. Results All 20 flaps survived completely. The patients were follow-up for 6 to 12 months. The color, texture and contour of the flaps were good. Two-points discrimination was 7 to 10 mm on the flap. The function was assessed as excellent in 16 fingers, good in 3 fingers and fair in 1 finger. No complication occurred in the donor site. Conclusion This flap spares the main digital artery and nerve. It is an improvement to the conventional fascia flap and presents as a new method for the treatment of thumb skin defect.
出处
《中华手外科杂志》
CSCD
北大核心
2017年第1期15-17,共3页
Chinese Journal of Hand Surgery
关键词
拇指
外科皮瓣
穿支
Thumb
Surgical flaps
Perforator
