摘要
目的 观察指背逆行岛状筋膜蒂皮瓣移植修复术和指蹼动脉穿支为蒂逆行岛状皮瓣移植修复术两种术式修复手指末节皮肤缺损的效果。方法 2020年1月~2023年1月收治的手指末节皮肤缺损病人100例,依据皮瓣存活情况,纳入皮瓣存活的病人91例,根据修复方法不同分为两组,其中指背组33例,指蹼组58例,比较2组皮瓣存活率及皮瓣存活病人的手术效果。结果指背组皮瓣存活率(82.50%,33/40)低于指蹼组(96.67%,58/60),术后并发症发生率(27.27%)高于指蹼组(8.61%),两组比较差异有统计学意义(P<0.05)。指背组皮瓣长度、手术时间分别为(6.02±1.20) cm和(61.27±7.15)分钟,较指蹼组的[(8.60±1.82) cm、(100.25±15.20)分钟]短,两组比较差异有统计学意义(P<0.05)。指背组创面愈合时间、住院时间分别为(18.02±3.50)天、(16.20±1.50)天,较指蹼组的(13.50±2.77)天、(12.50±1.80)天长,两组比较差异有统计学意义(P<0.05)。指背组术后7天、出院当日毛细血管充盈时间分别为(1.57±0.14)秒和(1.12±0.08)秒,较指蹼组的[(1.13±0.10)秒和(0.95±0.06)秒]长,感觉功能评分分别为(2.51±0.34)分和(3.77±0.38)分,较指蹼组的[(3.34±0.40)分、(4.12±0.21)分]低,两组比较差异有统计学意义(P<0.05)。指背组术后7天IL-6、TNF-α水平分别为(29.95±4.80)ng/L、(197.25±13.50) ng/L,较指蹼组的[(27.02±4.15) ng/L、(185.62±12.27) ng/L]高,两组比较差异有统计学意义(P<0.05)。术后6个月随访结果显示,与指背组比较,指蹼组手功能评分中运动评分、工作能力评分更高,手功能恢复优良率(93.10%vs 81.82%)更高,两点辨别觉更短,两组比较差异有统计学意义(P<0.05)。结论 不同逆行岛状皮瓣修复术式均可有效修复手指末节皮肤缺损,促进创面愈合,其中指蹼动脉穿支为蒂逆行岛状皮瓣修复术具有皮瓣存活率更高、手功能改善更为明显、术后炎症反应较轻等优势,指背逆行岛状筋膜蒂皮瓣移植修复术手术时间相对较短。
Objective To observe the results of two surgical procedures,retrograde island fascia-tipped flap graft repair on the dorsum of the finger and retrograde island flap graft repair with the perforating branch of the finger web artery as the tip,in repairing skin defects at the end of the finger.Method From January 2020 to January 2023,100 patients with skin defects at the distal phalanges of the fingers were admitted.According to the survival status of the flaps,91 patients with surviving flaps were included and divided into two groups based on different repair methods,including 33 cases in the dorsal phalanx group and 58 cases in the webbed phalanges group.Compare the survival rate of flaps and the surgical outcomes of patients with surviving flaps in the two groups.Results The flap survival rate in the dorsal phalanx group(82.50%,33/40)was lower than that in the webbed phalanges group(96.67%,58/60),and the incidence of postoperative complications(27.27%)was higher than that in the webbed phalanges group(8.61%).There was a statistically significant difference between the two groups(P<0.05).The flap length and operation time[(6.02±1.20)cm,(61.27±7.15)min]in the dorsal finger group were shorter than those in the webbed finger group[(8.60±1.82)cm,(100.25±15.20)min],the wound healing time and hospital stay in the dorsal finger group were(18.02±3.50)days and(16.20±1.50)days respectively,which were longer than those in the webbed finger group[(13.50±2.77)days and(12.50±1.80)days],there was a statistically significant difference between the two groups(P<0.05).The capillary filling times of the dorsal finger group at 7 days after the operation and on the day of discharge were(1.57±0.14)s and(1.12±0.08)s,respectively,which were longer than those of the webbed finger group[(1.13±0.10)s and(0.95±0.06)s],the sensory function scores were(2.51±0.34)points and(3.77±0.38)points,respectively,which were lower than those of the webbing group[(3.34±0.40)points,(4.12±0.21)points],and the difference between the two groups was statistically significant(P<0.05).The levels of IL-6 and TNF-αat 7 days after operation[(29.95±4.80)ng/L,(197.25±13.50)ng/L]were higher than those in the fingerweb group[(27.02±4.15)ng/L,(185.62±12.27)ng/L],the differences were statistically significant(P<0.05).The follow-up results showed that compared with the finger dorsal group,the hand function score of the finger web group was higher,the hand function recovery rate was higher(93.10%vs 81.82%),and the two-point discrimination was shorter(P<0.05).Conclusion Different retrograde island flap repair methods can effectively repair the skin defect of the finger end and promote wound healing,among which the retrograde island flap repair with pedicled perforator of the finger web artery has the advantages of higher survival rate of the flap,more obvious improvement of hand function,and less postoperative inflammation,the retrograde island fascial flap transplantation repair of the dorsal finger is relatively short.
作者
范文潮
徐剑
杨洪军
王森
刘园
FAN Wenchao;XU Jian;YANG Hongjun;WANG Sen;LIU Yuan(Department of Hand Surgery,Changzhou Traditional Chinese Medicine Hospital,Changzhou 213000,China;不详)
出处
《临床外科杂志》
2025年第11期1218-1221,共4页
Journal of Clinical Surgery
基金
江苏省高等学校自然科学研究项目(19EDR230327)。
关键词
手指末节皮肤缺损
皮瓣修复术
临床效果
skin defects of the terminal phalanges of the fingers
flap repair
clinical results
