中国修复重建外科杂志

中国修复重建外科杂志

指尖横形离断伤的分型及修复方法探讨

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目的 探讨指尖横形离断伤新的分型和修复方法。 方法 2000 年3 月- 2006 年10 月,收治20 例指尖横形离断伤。男13 例13 指,女7 例7 指;年龄17 ~ 47 岁。挤压伤9 例,切割伤5 例,电锯伤6 例。指尖横形离断伤分为4 型:Ⅰ型为甲床远1/3 平面,Ⅱ型为甲床中段平面,Ⅲ型为甲床近1/3 平面,Ⅳ型为甲根平面。Ⅰ型中示指2 例,小指1 例;Ⅱ型中拇指2 例,示指、中指各3 例;Ⅲ型中示指3 例,环指、小指各1 例;Ⅳ型中拇指2 例,中指、小指各1 例。缺损范围1.2 cm × 1.2 cm ~ 1.5 cm × 1.2 cm。伤后至手术时间3 ~ 10 h。其中Ⅰ、Ⅱ型应用带血管神经束顺行岛状皮瓣,并行改良甲床扩大术;Ⅲ、Ⅳ型应用带血管神经束顺行岛状皮瓣与甲床回植,行改良甲床扩大术。术中皮瓣切取范围1.5 cm × 1.2 cm ~ 2.0 cm × 1.4 cm。 结果 术后皮瓣及甲床均成活,切口Ⅰ期愈合。供区植皮均成活,创面Ⅰ期愈合。患者均获随访,随访时间2 ~ 6 个月,平均4 个月。皮瓣外形饱满、质软,肤色和皮温均正常,两点辨别觉4.5 ~ 6.5 mm。Ⅰ、 Ⅱ型患指指甲较术前延长3 ~ 4 mm;Ⅲ、Ⅳ型患指指甲较术前延长8 ~ 10 mm。1 例术后6 个月出现钩甲畸形,未作处理。指甲光滑、无压痛,甲床平整无甲棘;患指各关节活动无影响。 结论 对指尖离断伤损伤平面进行分型后采用不同的修复方法,有利于最大程度恢复指尖功能和外形。

Objective To investigate new classification and repair methods for the traverse amputated fingertip. Methods From March 2000 to October 2006, 20 cases of 20 fingers with traverse amputated fingertip, including 13 males and 7 females aged 17-47 years, were treated. Twenty patients (9 crush injuries, 5 cutting injuries and 6 sawing injuries) were classified into 4 types, namely type I (the distal one third of nail bed), type II (the middle of nail bed), type III (the poximal one third of nail bed), and type IV (the root of nail bed). There were 3 patients (2 index fingers and 1 l ittle finger) of type I, 8 patients (2 thumbs, 3 index fingers and 3 middle fingers) of type II, 5 patients (3 index fingers, 1 ring finger and 1 l ittle finger)
of type III, and 4 patients (2 thumbs, 1 middle finger and 1 l ittle finger) of type IV. The soft tissue defect ranged from 1.2 cm × 1.2 cm to 1.5 cm × 1.2 cm. The time from injury to surgery was 3-10 hours. Fingers of type I and type II were treated with forward flow axial flap and modified nail bed lengthening. Fingers of type III and type IV were treated with forward flow axial flap and partial nail bed replantation as well as modified nail bed lengthening. The flaps ranged in size from 1.5 cm × 1.2 cm to 2.0 cm × 1.4 cm. Results Twenty patients incisions healed by first intention and the flaps, nails and skin grafting survived. All donor sites healed by first intention. All patients were followed up for 2-6 months (4 months on average). The appearances of fingertips were good. The texture of the flap was soft, and the fingers had no tenderness and motor disturbance. The two-point discrimination was 4.5-6.5 mm.The finger nails of type I and type II extended 3-4 mm after operation, while the finger nails of type III and type IV extended 8-10 mm after operation. All finger nails were smooth and flat without pain. Hook nail happened in 1 case 6 months after operation. Conclusion Classification of the injured fingers according to the condition of the amputation base is helpful in choosing repair methods, and is conducive to maximize the recovery of the function and shape of fingertips.

关键词: 指尖离断; 分型; 岛状皮瓣; 甲床回植; 甲床扩大

Key words: Fingertip amputation; Classification; Island flap; Nail bed replantation; Nail bed expansion

引用本文: 周晓,许亚军,芮永军,姚群. 指尖横形离断伤的分型及修复方法探讨. 中国修复重建外科杂志, 2008, 22(9): 1089-1091. doi: 复制

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