中国修复重建外科杂志

中国修复重建外科杂志

同指近节指动脉背侧支皮瓣修复末节缺失的指中节脱套伤

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目的 探讨同指近节指动脉背侧支皮瓣修复末节缺失的指中节脱套伤疗效。 方法 2013 年 2 月—2016 年 7 月,收治 11 例(11 指)末节缺失的指中节套脱伤患者。男 9 例,女 2 例;年龄 18~59 岁,平均 33.6 岁。致伤原因:绞伤 8 例,碾压伤 3 例。损伤指别:示指 3 例,中指 6 例,环指 2 例。手指套脱范围:近指间关节以远 1 例,中节指骨近 1/4 以远 6 例,中节指骨中 1/2 以远 4 例。皮肤软组织缺损范围 4.0 cm×1.7 cm~6.2 cm×2.6 cm。受伤至手术时间 2.5~6.0 h,平均 4.5 h。采用同指近节指固有动脉背侧支皮瓣修复,皮瓣切取范围为 4.4 cm×1.9 cm~7.0 cm×2.9 cm;皮瓣内携带的指固有神经背侧支与创面指固有神经残端吻合。供区游离植皮修复。 结果 术后 1 例皮瓣远端出现水疱、结痂,经换药后愈合;其余皮瓣顺利成活,创面Ⅰ期愈合。供区植皮均顺利成活,切口Ⅰ期愈合。11 例均获随访,随访时间 6~18 个月,平均 16 个月。皮瓣外观良好;术后 6 个月皮瓣两点辨别觉为 7~10 mm,平均 8.5 mm。末次随访时,按中华医学会手外科学分会上肢部分功能评定试用标准评定:优 10 例,良 1 例;优良率 100%。 结论 同指近节指动脉背侧支皮瓣修复末节缺失的指中节套脱伤手术操作简便,供区损伤小,术后皮瓣成活率高,感觉恢复较好,是一种较好的修复方法。

Objective To investigate the effectiveness of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect. Methods Between February 2013 and July 2016, 11 cases (11 fingers) of mid-phalanx degloving injury with distal segment finger defect were treated. There were 9 males and 2 females with an average age of 33.6 years (range, 18-59 years). The injury caused by twisting in 8 cases and crushing in 3 cases. The injury located at index finger in 3 cases, middle finger in 6 cases, and ring finger in 2 cases. The skin avulsion was from proximal interphalangeal joint in 1 case, proximal 1/4 of mid-phalanx in 6 cases, and 1/2 of mid-phalanx in 4 cases. The area of wounds ranged from 4.0 cm×1.7 cm to 6.2 cm×2.6 cm. The interval between injury and operation was 2.5-6.0 hours (mean, 4.5 hours). All defects were repaired with the ipsilateral digital proper artery dorsal branch flaps. The size of flaps ranged from 4.4 cm×1.9 cm to 7.0 cm×2.9 cm. Nerve anastomose was carried between digital proper nerve dorsal branch in the flap and digital proper nerve stump in the wound. The donor sites were repaired by skin grafting. Results Tension blisters of the flap and partial necrosis occurred in 1 case, and healed after dressing change. The other flaps and skin grafting survived, and wounds healed by first intention. All patients were followed up 6-18 months (mean, 16 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination of flaps ranged from 7 to 10 mm (mean, 8.5 mm). At last followed-up, according to the functional assessment criteria of upper limbs by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 10 cases and good in 1 case, with the excellent and good rate of 100%. Conclusion The ipsilateral digital proper artery dorsal branch flap is a good method to repair mid-phalanx degloving injury with distal segment finger defect for the advantages of simple operation, less damage in donor site, high survival rate of the flap, and good feeling recovery of the finger.

关键词: 指损伤; 近节指动脉背侧支皮瓣; 套脱伤; 创面修复

Key words: Finger injury; digital proper artery dorsal branch flap; degloving injury; wound repair

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