摘要
目的分析比较顺行及逆行指动脉岛状皮瓣修复指端缺损的临床疗效。方法 2015年1月至2016年12月我院采用指动脉岛状皮瓣修复指端缺损35例,其中顺行指动脉岛状皮瓣修复(顺行组)14例,逆行指动脉岛状皮瓣修复(逆行组)21例。顺行组以一侧指固有动脉及神经为蒂,近节及中节手指指腹设计皮瓣,顺行推移修复指端缺损;逆行组以一侧指固有动脉为皮瓣轴线,根据指端缺损大小于手指近端一侧设计皮瓣,指固有神经游离出皮瓣,逆行转移修复指端缺损。结果 35例患者术后所有皮瓣均存活。顺行组出现1例静脉回流障碍,皮瓣穿刺放血后逐渐好转;逆行组出现3例血管危象,松解敷料及蒂部拆除部分缝线,2例恢复正常,1例皮瓣皮缘部分坏死,换药后创面愈合。顺行组手术时间(107.5±18.4)min,低于逆行组(139.5±18.0)min,2组比较差异有统计学意义(P<0.05)。35例患者术后均获随访,随访6~12个月,平均8.5个月。末次随访时,2组患者皮瓣外观无臃肿,颜色红润,质地软。顺行组12例感觉功能恢复至S4,2例S3;逆行组5例恢复至S3,12例S2,4例S1;顺行组两点辨别觉(4.22±0.67)mm,优于逆行组(7.04±1.25)mm,2组比较差异有统计学意义(P<0.05);顺行组指间关节活动度为远端(102.67±7.35)°及近端(64.46±8.37)°,逆行组分别为(100.64±10.29)°及(60.81±10.80)°,2组比较差异无统计学意义(P>0.05);患指功能评定顺行组优良率92.8%,逆行组80.9%,差异无统计学意义(P>0.05)。结论对于指端缺损(IshikawaⅠ~Ⅲ区)且皮肤软组织无回植条件的患者,采用顺行及逆行指动脉岛状皮瓣修复均可获得良好的临床效果,但带单侧指动脉及神经的顺行岛状皮瓣修复指端缺损具有手术时间短、感觉恢复佳等优势。
Objective To evaluate the clinical effect of anterograde and reverse digital artery island flap in treatment of wound repairing for fingertip defects. Methods From January 2015 to December 2016 ,there were 35 patients with fingertip defects underwent surgical treatment in our hospital, including 14 cases underwent surgery with anterograde digital artery island flap （ anterograde group） and 21 cases underwent surgery with reverse digital artery island flap（ reverse group）. The anterograde group used proper palmar digital artery and nerve as the pedicle of flap ,then took forward the finger pulp flap to the injured site. The reverse flap from the dorsal of one side of finger was harvested for coverage of the distal phalanx. Results All the flaps of the 35 cases were survived. In the anterograde group, reflux obstacle of vein appeared in I case,and it was cured with scarification procedures. In the reverse group,there were 3 cases of vascular crisis. After dressing release and partial remove of the stitching,2 cases of them returu to normal. The other l case suffered from flap edge necrosis, and then the wound healed after dressing change. The operation time of anterograde group was （ 107.5 ± 18.4） rain and it was （ 139.5 ± 18.0） rain in the reverse group, which showed significant difference between the two groups（ P 〈 0.05 ）. All the 35 cases were followed up for 6 to 12 months, with an average of 8.5 months. At the last follow-up, it showed that patients in both of the two groups had ruddy color, good texture and no significant bloated flap appearance. In the anterograde group,the sensory function of 12 patients restored to S4 and 2 patients restored to S3. Meanwhile,in reverse group,5 patients restored to S3,12 patients restored to S2, and 4 patients restored to S1. The two-points discrimination of the anterograde group was （4.22 ± 0.67） mm, and it was （7.04 ± 1.25 ）mm in the reverse group, which was significantly different （ P 〈 0.05 ）. The interphalaugeal joint motion was （102.67 ± 7.35 ）°at the distal end and （64.46 ± 8.37 ） ° at the proximal end in anterograde group. And it was （100.64 ± 10. 29） ° and （60. 81 ± 10. 80） ° respectively in the reverse group, with no significant difference between the two groups （ P 〉 0.05 ）. The excellent and good rate was 92.8% in the auterograde group and 80.9% in the reverse group by the criteria for functional evaluation, and there was no statistically significant difference （ P 〉 0.05 ）. Conclusion For fingertip defects （ Ishikawa I - III ） treated by anterograde digital artery island flap or reverse digital artery island flap both can obtained good clinical efficacy. But it has shorter operation time and better sensory recovery with anterograde digital artery island flap repairing.
出处
《局解手术学杂志》
2018年第2期102-106,共5页
Journal of Regional Anatomy and Operative Surgery
基金
2013年度军区医学科技创新课题项目(MS073)
关键词
指端缺损
指动脉岛状皮瓣
创面修复
指神经
fingertip defects
digital arterial island flap
wound repair
digital nerve
