摘要
目的探讨B形第一掌背皮神经营养血管皮瓣修复拇指末节脱套伤的临床效果。方法回顾性分析2015年3月至2018年6月永康市骨科医院收治的15例拇指末节脱套伤患者的临床资料。其中男10例,女5例,年龄24~61岁,损伤平面在指间关节以远7例,甲根部以远8例,脱套指末节长度1.8~2.3 cm,皮肤软组织缺损范围为1.8 cm×4.6 cm^2.3 cm×5.6 cm。采用B形第一掌背皮神经营养血管皮瓣修复拇指末节创面,同时将第一掌骨桡侧掌背神经与创面尺侧指固有神经断端吻合,供区取上臂全厚皮片移植修复。术后对拇指外形及功能进行随访,以英国医学研究会感觉功能评定标准测定皮肤感觉功能,参照中华医学会手外科学分会手指总主动活动度测定法评价拇指功能。结果皮瓣切取面积为2.0 cm×5.0 cm^2.5 cm×6.0 cm,全部成活。术后随访5~18个月,平均10个月,拇指修复处皮瓣质地柔软、耐磨、不臃肿、无明显色素沉着,恢复保护性感觉,两点辨距觉达8~11 mm,平均9.3 mm,基本恢复了拇指原有的外形及功能。皮瓣感觉功能达S3+13例,S32例。拇指功能评定为优9例,良6例。供区无瘢痕挛缩及感觉过敏等并发症。结论B形第一掌背皮神经营养血管皮瓣治疗拇指末节脱套伤,能同时完成皮肤覆盖和感觉重建,术后效果满意。
Objective To explore the clinical effect of repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap.Methods The clinical data included 15 patients with distal thumb degloving injury received in Yongkang Orthopedic Hospital from March 2015 to June 2018.These patients included 10 males and 5 females,aged between 24 and 61 years.For the injury,7 cases were beyond the interphalangeal joint,8 cases were beyond the nail root.The length of the distal segment of degloving finger was 1.8 to 2.3 cm,and the skin and soft tissue defect ranged from 1.8 cm×4.6 cm to 2.3 cm×5.6 cm.The distal thumb degloving injury was repaired with B-shaped first palmar dorsal neurocutaneous vascular flap.The radial dorsal metacarpal nerve of the first metacarpal was anastomosed with the ulnar proper digital nerve stump.And full-thickness skin graft transplantation was performed in donor area.After the operation,the shape and function of the thumb were followed up.The sensory function of the skin was determined by British Medical Research Association Sensory Function Evaluation Standard,and the function of the thumb was evaluated with reference to the total active movement(TAM)of fingers of the Chinese Medical Association Hand Surgery Branch.Results The flap area was 2.0 cm×5.0 cm-2.5 cm×6.0 cm,and all the flaps were survived.Follow-up period was 5-18 months after the operation,with an average of 10 months.The flap at the thumb repair site was soft,wear-resistant,non-bloated,no obvious pigmentation.Its protective sensation was restored.The two-point discrimination of the flap reached 8-11 mm,with an average of 9.3 mm,basically restoring the original shape and function of the thumb.There were 13 cases reaching the S3+flap sensory function,2 cases reaching S3.The thumb function was evaluated as excellent for 9 cases,and good for 6 cases.There were no complications such as scar contracture and hypersensitivity in the donor area.Conclusions The repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap can complete skin coverage and sensory reconstruction,with satisfactory postoperative effect.
作者
徐鸿杰
赵晓航
胡德锋
孙艺
马建安
胡振业
郑顺江
程永松
Xu Hongjie;Zhao Xiaohang;Hu Defeng;Sun Yi;Ma Jian'an;Hu Zhenye;Zheng Shunjiang;Cheng Yongsong(Department of Hand Surgery,Yongkang Orthopedic Hospital,Zhejiang Province,Yongkang 321300,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第6期660-663,共4页
Chinese Journal of Plastic Surgery
