摘要
目的探讨应用第二掌背动脉（second dorsal metacarpal artery，sDMA）逆行岛状皮瓣修复示、中指中末节皮肤套状撕脱伤的方法及疗效。方法2004年5月至2010年1月，收治17例示指或中指中末节皮肤套状撕脱伤患者。采用SDMA岛状皮瓣进行修复，并缝合指背神经。皮瓣切取面积为2．5cm×5．6cm～5．0cm×6．5cm，供区创面行游离植皮。结果术后2例皮瓣远端出现张力性水泡，表皮结痴，经换药后愈合；其余皮瓣顺利存活。皮瓣及供区植皮切口均工期愈合。术后17例获得4—27个月的随访，平均15．3个月。皮瓣质地柔软，外观饱满无臃肿。两点分辨觉为7．11mm，平均8．6mm。手功能按手指总主动活动度（total active movement，TAM）法评定：优8指，良7指，可2指；优良率为88．2％。结论缝合指背神经的改良SDMA逆行岛状皮瓣，皮瓣切取面积足够覆盖示、中指中末节套状撕脱伤皮肤缺损创面，皮瓣血运可靠，手术安全，是一种较好的手术方法。
Objective To inves-tigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery （SDMA） for repairing index or long finger degloving defects. Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA. The domal digital nerve in the flap was coapted to the severed proper digital nerve. The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0cm × 6.5 cm. The donor sites were closed by skin graft. Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change. All the other flaps survived uneventfully. Primary healing of the flaps and donor sites was achieved. All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months. The flaps were pliable, full but not bulky. Two-point discrimination was 7 to 11 mm （mean 8.6 mm）. Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers. The satisfactory rate was 88.2 %. Condusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries. The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx. The surgery is safe due to the reliable flap circulation.
出处
《中华手外科杂志》
CSCD
北大核心
2011年第2期87-89,共3页
Chinese Journal of Hand Surgery
关键词
指损伤
岛状皮瓣
修复外科手术
Finger injuries
Island flaps
Reconstructive surgical procedures
