前臂外侧皮神经终末支营养血管皮瓣修复拇指指端或指腹创面的临床效果

王辉; 杨晓溪; 霍永鑫; 郝睿峥; 常红; 刘伟; 王斌

doi:10.3760/cma.j.cn501120-20200607-00298

前臂外侧皮神经终末支营养血管皮瓣修复拇指指端或指腹创面的临床效果

doi: 10.3760/cma.j.cn501120-20200607-00298

王辉^1, ,,
杨晓溪²,
霍永鑫¹,
郝睿峥¹,
常红¹,
刘伟¹,
王斌¹

1.
唐山市第二医院手外科　　063000
2.
华北理工大学中医学院，唐山　　063210

基金项目:

河北省高层次人才资助项目 A201901124

河北省医学科学研究课题计划 20201453

河北省医学适用技术跟踪项目 GZ2021030

河北省省级科技计划自筹经费项目 182777137

详细信息

通讯作者:
王辉，Email：wanghuiyxx@163.com

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出版历程
- 收稿日期: 2020-06-07

Clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb

1.
Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
2.
College of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan 063210, China

Funds:

High-level Talent Support Project of Hebei Province of China A201901124

Medical Science and Research Project Plan of Hebei Province of China 20201453

Tracking Project of Medical Applicable Technology in Hebei Province of China GZ2021030

Science and Technology Self-financing Project of Hebei Province of China 182777137

More Information

Corresponding author: Wang Hui, Email: wanghuiyxx@163.com

摘要

摘要: 目的探讨前臂外侧皮神经终末支营养血管皮瓣修复拇指指端、指腹创面的临床效果。方法采用回顾性观察性研究方法。2016年2月—2019年4月，唐山市第二医院收治符合入选标准的21例（21指）拇指指端、指腹创面患者，其中男13例、女8例，年龄21~65岁，缺损部位：指端14例、指腹7例，均存在骨骼和/或肌腱外露。本组患者清创后创面面积为2.0 cm×1.5 cm~4.0 cm×2.7 cm，均采用前臂外侧皮神经终末支营养血管皮瓣修复，皮瓣切取面积为2.3 cm×1.8 cm~4.3 cm×3.0 cm。术中将皮瓣携带的前臂外侧皮神经终末支与创面内指固有神经残端吻合，供区直接缝合。观察术后皮瓣成活、供区伤口愈合情况及随访时皮瓣和供瓣区外观。末次随访时，测量皮瓣静态两点辨别觉距离，参照Michigan手部功能问卷评定标准评估患者对患手外观满意度，测量患指与健侧拇指关节总主动活动度（TAM）及患手与健手虎口角。对数据行配对样本t检验。结果术后21例患者皮瓣全部成活，血运良好、无感染；供区伤口愈合。所有患者均获随访，时间8~22个月，皮瓣外形良好，颜色及质地与周围组织相近；指端及指腹无疼痛，皮瓣无异位感，拇指桡侧供区仅残留轻微线性瘢痕。末次随访时，本组患者皮瓣静态两点辨别觉距离为6~11 mm。18例患者对患手外观表示非常满意，3例患者对患手外观表示满意。本组患者患指TAM为（140±5）º、患手虎口角为（94±9）°，分别与健侧拇指的（141±5）°、健手的（95±9）°相近（t=-2.024、-1.142，P>0.05）。结论前臂外侧皮神经终末支营养血管皮瓣解剖恒定、操作简便，修复拇指指端、指腹创面后，拇指外形美观、功能恢复好，为拇指指端、指腹创面修复提供了一种较佳的治疗方法，尤其适合急诊开展。
- 外科皮瓣 /
- 拇指 /
- 指损伤 /
- 皮神经营养血管皮瓣 /
- 前臂外侧皮神经 /
- 创面修复
Abstract: Objective To investigate the clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb. Methods A retrospective observational study was conducted. From February 2016 to April 2019, a total of 21 patients (21 fingers) with finger tip or finger pulp wounds of the thumbs met the inclusion criteria and were admitted to the Second Hospital of Tangshan, including 13 males and 8 females, aged 21 to 65 years, with the defects located at the finger tips of 14 patients and the finger pulps of 7 patients, and all having exposed bones and/or tendons. The wound sizes of patients in this group after debridement ranged from 2.0 cm×1.5 cm to 4.0 cm×2.7 cm. All the wounds were repaired with the neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve, with the flap sizes ranging from 2.3 cm×1.8 cm to 4.3 cm×3.0 cm. In surgery, the terminal branch of lateral antebrachial cutaneous nerve carried by the flaps was anastomosed with the end of the proper digital nerve of the wounds. The donor sites of flaps were sutured directly. The survival of flaps and healing of wounds in donor sites after operation were observed. The appearance of flaps and donor sites were observed during follow-up. At the final follow-up, the static two-point discrimination distances of the flaps were measured, and the degree of satisfaction of patients for the appearances of injured hands were evaluated based on Michigan Hand Function Questionnaire. The total action motion (TAM) of the injured and contralateral thumbs and the angle of thumb web of the injured and contralateral hands were measured. Data were statistically analyzed with paired sample t test. Results All the flaps of the 21 patients survived with good blood supply and no infection. The wounds at the donor sites were all healed. All the patients were followed up, with the time ranging from 8 to 22 months. The appearances of flaps were good with their color and texture similar to the surrounding tissue. There was no pain in the finger tip or finger pulp, nor any ectopic sensation in flaps. There was only some linear scar left at the radial side of thumb. At the final follow-up, the static two-point discrimination distances of the flaps of the patients were 6 to 11 mm; 18 patients were very satisfied and 3 patients were satisfied with the overall appearance of the injured hand. The TAM of injured thumbs and the angle of thumb web of the injured hands of the patients were respectively (140±5)º and (94±9)°, which were similar to (141±5)º of the thumbs and (95±9)° of hands in the contralateral side, respectively (t=-2.024, -1.142, P>0.05). Conclusions The neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve has constant anatomy and is easy to perform. It can repair the finger tip or finger pulp wounds of the thumb achieving good appearance and function recovery. It provides a good option for repair of finger tip or finger pulp wounds of the thumb and is especially suitable for emergency application.
- Surgical flaps /
- Thumb /
- Finger injuries /
- Neurocutaneous vascular flaps /
- Lateral antebrachial cutaneous nerve /
- Wound repair
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1 拇指背侧前臂外侧皮神经终末支营养血管皮瓣修复机器绞伤致左拇指指腹创面。1A.术前左拇指桡侧观，可见指腹皮肤软组织缺损；1B.术前左拇指背侧观，可见指甲缺失；1C.术中前臂外侧皮神经营养血管皮瓣设计；1D.术中皮瓣切取并携带前臂外侧皮神经；1E.术后即刻患指指腹皮瓣外观及血运良好；1F.术后8个月随访掌侧观，可见患指指腹皮瓣外形良好、不臃肿；1G.术后8个月随访背侧观，可见患指指甲平整，供瓣区仅残留轻微线性瘢痕；1H.术后8个月随访，患指对掌功能良好

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脱细胞真皮基质（ADM）	重症监护病房（ICU）	动脉血氧分压（PaO₂）
丙氨酸转氨酶（ALT）	白细胞介素（IL）	磷酸盐缓冲液（PBS）
急性呼吸窘迫综合征（ARDS）	角质形成细胞（KC）	反转录-聚合酶链反应（RT-PCR）
天冬氨酸转氨酶（AST）	半数致死烧伤面积（LA50）	全身炎症反应综合征（SIRS）
集落形成单位（CFU）	内毒素/脂多糖（LPS）	超氧化物歧化酶（SOD）
细胞外基质（ECM）	丝裂原活化蛋白激酶（MAPK）	动脉血氧饱和度（SaO₂）
表皮生长因子（EGF）	最低抑菌浓度（MIC）	体表总面积（TBSA）
酶联免疫吸附测定（ELISA）	多器官功能障碍综合征（MODS）	转化生长因子（TGF）
成纤维细胞（Fb）	多器官功能衰竭（MOF）	辅助性T淋巴细胞（Th）
成纤维细胞生长因子（FGF）	一氧化氮合酶（NOS）	肿瘤坏死因子（TNF）
3-磷酸甘油醛脱氢酶（GAPDH）	负压伤口疗法（NPWT）	血管内皮生长因子（VEGF）
苏木精-伊红（HE）	动脉血二氧化碳分压（PaCO₂）	负压封闭引流（VSD）

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参考文献(37)

[1]	张世民,徐达传. 带皮神经及其营养血管的皮瓣[J]. 中国临床解剖学杂志, 1996, 14(4):313-315.DOI: 10.13418/j.issn.1001-165x.1996.04.039.
[2]	钟世镇, 徐永清, 周长满, 等. 皮神经营养血管皮瓣解剖基础及命名[J]. 中华显微外科杂志, 1999, 22(1):37-39. DOI: 10.3760/cma.j.issn.1001-2036.1999.01.014.
[3]	齐杰,李雯,刘艳杰,等.前臂外侧皮神经营养血管逆行蒂岛状皮瓣修复手背软组织缺损[J].中华整形外科杂志,2010,26(4):241-243.DOI: 10.3760/cma.j.issn.1009-4598.2010.04.001.
[4]	邹锦考,邓国权,莫凤莲,等.前臂外侧皮神经营养血管皮瓣的临床应用[J].中华显微外科杂志,2014,37(4):398-399.DOI: 10.3760/cma.j.issn.1001-2036.2014.04.027.
[5]	谢艾玲,张荐,卢爱东,等.逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤缺损[J].中国修复重建外科杂志,2014,28(12):1498-1501.DOI: 10.7507/1002-1892.20140324.
[6]	李慧,魏在荣,杨胜波.前臂皮神经营养血管皮瓣解剖学基础与感觉重建临床应用进展[J].解剖学杂志,2019,42(1):74-77.DOI: 10.3969/j.issn.1001-1633.2019.01.019.
[7]	LiH,ZhuWW,WuSW,et al.Anatomical analysis of antebrachial cutaneous nerve distribution pattern and its clinical implications for sensory reconstruction[J].PLoS One,2019,14(9):e0222335.DOI: 10.1371/journal.pone.0222335.
[8]	KanchanathepsakT, RojpitipongsakornC, TawonsawatrukT, et al. The lateral antebrachial neurocutaneous flap: a cadaveric study and clinical applications [J]. J Reconstr Microsurg, 2020, 36(7):541-548. DOI: 10.1055/s-0040-1710551.
[9]	LucchinaS,FusettiC,LazzaroL,et al. End-to-side innervated sensate radial forearm flap in the hand: a 5-year follow-up[J].Hand Surg Rehabil,2019,38(3):207-210.DOI: 10.1016/j.hansur.2019.03.005.
[10]	ChungKC,PillsburyMS,WaltersMR,et al.Reliability and validity testing of the Michigan Hand Outcomes Questionnaire[J].J Hand Surg Am,1998,23(4):575-587.DOI: 10.1016/S0363-5023(98)80042-7.
[11]	BrambulloT, Dalla VeneziaE, VindigniV,et al. Extended Hueston flap: new solution for primary closure[J]. J Hand Microsurg, 2018, 10(3):155-157. DOI: 10.1055/s-0038-1636833.
[12]	CuiMY, WangPJ. Fingertip reconstruction using a lateral flap based on the distal transverse arch of the digital artery[J]. Ann Plast Surg, 2020, 84(5S Suppl 3):S186-189. DOI: 10.1097/SAP.0000000000002370.
[13]	WangH,ChenC,LiJ,et al.Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects[J].J Hand Surg Eur Vol,2016,41(2):177-184.DOI: 10.1177/1753193415610529.
[14]	池征璘,陈一衡,罗鹏,等.改良示指背侧岛状皮瓣修复拇指指端软组织缺损[J].中华显微外科杂志,2019,42(3):228-231.DOI: 10.3760/cma.j.issn.1001-2036.2019.03.005.
[15]	TorosT,GurbuzY,KelesogluB,et al.Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger[J].J Hand Surg Eur Vol,2018,43(10):1036-1043.DOI: 10.1177/1753193418778447.
[16]	González PortoSA, Postigo MarcosEB, Fernández MarcosAA, et al. First dorsal metacarpal flap refinement for coverage of thumb defects[J]. J Plast Reconstr Aesthet Surg, 2019, 72(2):335-354. DOI: 10.1016/j.bjps.2018.11.016.
[17]	HuDQ,WeiZR,WangTQ,et al.Anatomical basis and clinical application of the dorsal perforator flap based on the palmar artery in the first web[J].Surg Radiol Anat,2020,42(3):269-276.DOI: 10.1007/s00276-019-02376-8.
[18]	ShubinetsV, ElliottRM. Ulnar thumb pulp reconstruction using the anterograde homodigital neurovascular island flap[J]. J Hand Surg Am, 2018, 43(1):89.e1-89.e7. DOI: 10.1016/j.jhsa.2017.10.013.
[19]	LiuHJ, RegmiS, HeYY, et al. Thumb tip defect reconstruction using neurovascular island pedicle flap obtained from long finger[J]. Aesthetic Plast Surg, 2016, 40(5):755-760. DOI: 10.1007/s00266-016-0674-1.
[20]	WangH,YangXX,ChenC,et al. Modified Littler flap for sensory reconstruction of large thumb pulp defects[J].J Hand Surg Eur Vol,2018,43(5):546-553.DOI: 10.1177/1753193417754191.
[21]	刘刚义,郑龙,刘宗义,等.拇指背皮神经营养血管皮瓣修复拇指远端软组织缺损[J].中华显微外科杂志,2017,40(4):342-344.DOI: 10.3760/cma.j.issn.1001-2036.2017.04.008.
[22]	FanAW, SongLH, ZhangHL, et al. Reconstruction of finger pulp defects with an innervated distally-based neurovascular flap[J]. J Hand Surg Am, 2020, 45(5):454.e1-454.e8. DOI: 10.1016/j.jhsa.2019.10.018.
[23]	MaoT,XieRG,WangGH,et al.Application of a modified dorsoulnar artery pedicle flap in the repair of thumb tip defects: a case report[J].Exp Ther Med,2020,19(5):3300-3304.DOI: 10.3892/etm.2020.8583.
[24]	QinHJ,MaT,XiaJ,et al. Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle[J].Arch Orthop Trauma Surg,2020,140(7):987-992.DOI: 10.1007/s00402-020-03467-7.
[25]	万强, 赵云珍, 赵岩. 缝接神经的带蒂顺行指掌侧固有动脉皮瓣修复拇指软组织缺损[J]. 中华显微外科杂志, 2019, 42(6):584-587. DOI: 10.3760/cma.j.issn.1001-2036.2019.06.018.
[26]	孙海军,兰登哲,孙同新,等.不同皮瓣修复拇指指端软组织缺损疗效观察[J].中华手外科杂志,2018,34(1):53-54.DOI: 10.3760/cma.j.issn.1005-054X.2018.01.022.
[27]	CherubinoM, CornoM, ValdattaL, et al. Thumb reconstruction with thin proximal ulnar perforator free flap[J]. J Hand Surg Am, 2017, 42(2):e133-e138. DOI: 10.1016/j.jhsa.2016.11.026.
[28]	孙鹏,战杰,王思夏.游离尺动脉腕上皮支上行穿支皮瓣修复拇指软组织缺损[J].中华显微外科杂志,2019,42(2):187-189.DOI: 10.3760/cma.j.issn.1001-2036.2019.02.023.
[29]	晏桂明,王小立,刘宏国,等.𧿹趾腓侧游离皮瓣修复拇指和手指掌侧软组织缺损的临床经验[J].中华显微外科杂志,2018,41(6):589-591.DOI: 10.3760/cma.j.issn.1001-2036.2018.06.020.
[30]	UsamiS, InamiK, HiraseY, et al. An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction[J]. J Hand Surg Eur Vol, 2020, 45(8):842-848. DOI: 10.1177/1753193420939379.
[31]	ZhaoXF, GuoJ, DingJY, et al. Clinical effect of thumb finger reconstruction using dorsal foot flap transplant for treating thumb defects[J]. Med Hypotheses, 2020, 134:109435. DOI: 10.1016/j.mehy.2019.109435.
[32]	KodairaS, FukumotoK. Use of distal hypothenar perforator free flaps for pulp defects[J]. J Hand Surg Asian Pac Vol, 2020, 25(1):20-25. DOI: 10.1142/S2424835520500022.
[33]	KubotaY, MitsukawaN, ChumaK, et al. Hyperpigmentation after surgery for a deep dermal burn of the dorsum of the hand: partial-thickness debridement followed by medium split-thickness skin grafting vs full-thickness debridement followed by thick split-thickness skin grafting[J/OL]. Burns Trauma, 2016, 4:9[2020-06-07]. https://pubmed.ncbi.nlm.nih.gov/27574679. DOI: 10.1186/s41038-016-0039-7.
[34]	BertelliJA, KhouryZ. Neurocutaneous island flaps in the hand: anatomical basis and preliminary results[J]. Br J Plast Surg, 1992, 45(8):586-590. DOI: 10.1016/0007-1226(92)90024-r.
[35]	MasqueletAC, RomanaMC, WolfG. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg[J]. Plast Reconstr Surg, 1992, 89(6):1115-1121. DOI: 10.1097/00006534-199206000-00018.
[36]	周莉萍, 张文浩, 王玉龙. 远位埋没缝合切口减张技术联合电子线照射治疗瘢痕疙瘩九例[J]. 中华整形外科杂志, 2019, 35(3):278-281. DOI: 10.3760/cma.j.issn.1009-4598.2019.03.013.
[37]	OgawaR. Surgery for scar revision and reduction: from primary closure to flap surgery[J/OL]. Burns Trauma, 2019, 7:7[2020-06-07]. https://pubmed.ncbi.nlm.nih.gov/30891462/.DOI: 10.1186/s41038-019-0144-5.