摘要
目的 探讨采用拇指背侧皮神经营养血管皮瓣联合示指背侧邻指皮瓣瓦合修复拇指末节脱套缺损的手术方法和临床疗效.方法 2014年1月-2016年5月,采用拇指背侧皮神经营养血管皮瓣联合示指背侧邻指皮瓣瓦合修复拇指末节脱套缺损16例16指;左拇指6例,右拇指10例.拇指背侧皮神经营养血管皮瓣切取范围2.0 cm×2.0 cm^3.5 cm×2.5 cm,示指背侧邻指皮瓣切取范围2.0 cm×2.2 cm^3.5 cm×2.5 cm;皮瓣供区取中厚皮片覆盖,加压固定.结果 16例32块皮瓣全部成活.术后随访3~24个月,皮瓣外形、质地均良好,恢复保护性感觉,皮瓣的两点辨别觉为8~10 mm;除未恢复指甲外,基本恢复了拇指原有的外形及功能.依中华医学会手外科学会上肢部分功能评定试用标准评定：优10例,良4例,中2例,优良率87.5%.结论 采用拇指背皮神经营养血管皮瓣联合示指背邻指皮瓣瓦合修复拇指末节脱套缺损,其操作简单、手术风险小、成功率高、疗效满意;既适于技术条件及设备好的医院开展,也适合基层医院推广应用.
Objective To discuss the clinical effect of the application of thedorsal thumbneurocutaneous flap combined with the indicis cross-finger flap on the repair of degloving injury of distal thumb. Methods From January 2014 to May 2016, 16 cases of the degloving injury of distalthumb were treated with this procedure. Left thumbs were in 6 cases and right in 10. The cutting range of neurocutaneous flaps of dorsal thumb was 2.0 cm×2.0 cm to 3.5 cm×2.5 cm; The size of the indicis cross-finger flaps varied from 2.0 cm×2.2 cm to 3.5 cm×2.5 cm. The donor site of flap was repaired by intermediate split thickness skin grafts with compression fixation. Results 16 of 32 flaps survived. The follow-up period ranged from 3 to 24 months. The appearance and texture of the flaps were good, the protective sensation was restored, flexion and extension of the fingers was normal, and two-point discrimination of the flaps was resumed to 8mm to 10mm. According to the functional assessment criteria of upper limb formulated by Hand Surgery Society of Chinese Medical Assosiation,the outcomes were graded as excellent in 10 cases, good in 4 cases, and fair in 2 cases, with the excellent and good rate of 87.5%. All the affected fingers restored to the original appearance and function. Conclusion Compared with the traditional surgical methods, the neurocutaneous flap of dorsal thumb combined with the indicis cross-finger flap for repair of degloving injury of distal thumb has several advantages, the operation is simpler, the risk is lower, the success rate is higher, andthe curative effect is more satisfied.
出处
《实用手外科杂志》
2017年第3期303-305,共3页
Journal of Practical Hand Surgery
关键词
拇指
脱套缺损
修复
瓦合皮瓣
Thumb
Degloving injury
Repair
Tile composite flap
