基于指动脉背侧支供血的蝶形皮瓣与螺旋桨皮瓣修复手指掌侧创面疗效的对比研究

孙旭; 殷宗琦; 郑捷新; 窦懿; 张勤; 付强; 张文龙; 易磊

doi:10.3760/cma.j.cn501225-20220714-00294

基于指动脉背侧支供血的蝶形皮瓣与螺旋桨皮瓣修复手指掌侧创面疗效的对比研究

doi: 10.3760/cma.j.cn501225-20220714-00294

孙旭¹,
殷宗琦¹,
郑捷新¹,
窦懿¹,
张勤¹,
付强²,
张文龙³,
易磊^1, ,

1.
上海交通大学医学院附属瑞金医院灼伤整形科，上海　　200025
2.
解放军中部战区总医院骨科，武汉　　430072
3.
天津市人民医院手外科，天津　　300121

详细信息

通讯作者:
易磊，Email：yilei707@icloud.com

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出版历程
- 收稿日期: 2022-07-14

A comparative study of the curative effects between butterfly-shaped flap and propeller flap based on the dorsal branch of digital artery in repairing the wound in volar aspect of finger

1.
Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2.
Department of Orthopedics, General Hospital of PLA Central Theater Command, Wuhan 430072, China
3.
Department of Hand Surgery, the People's Hospital of Tianjin, Tianjin 300121, China

More Information

Corresponding author: Yi Lei, Email: yilei707@icloud.com

摘要

摘要: 目的对比基于指动脉背侧支供血的蝶形皮瓣（以下简称蝶形皮瓣）与基于指动脉背侧支供血的螺旋桨皮瓣（以下简称螺旋桨皮瓣）修复手指掌侧创面的疗效。方法采用回顾性队列研究方法。2018年8月—2022年4月，上海交通大学医学院附属瑞金医院收治16例、解放军中部战区总医院收治7例符合入选标准的手指掌侧创面患者，其中男14例、女9例，年龄25~64岁，清创或皮肤良性肿瘤切除术后创面面积为0.5 cm×0.5 cm~1.5 cm×1.5 cm。按照创面修复时皮瓣蒂部旋转轴向，将患者分为蝶形皮瓣组（8例）和螺旋桨皮瓣组（15例），分别采用蝶形皮瓣（面积为0.5 cm×0.5 cm~1.5 cm×1.3 cm）和螺旋桨皮瓣（面积为0.7 cm×0.5 cm~1.5 cm×1.5 cm）修复创面。螺旋桨皮瓣组供区创面取手腕掌侧或腹股沟处全厚皮片游离移植修复。记录2组患者手术时间，术后并发症、皮瓣成活情况和创面愈合时间。对数据行独立样本 t检验、Mann-Whitney U检验、Fisher确切概率法检验。结果蝶形皮瓣组患者手术时间、术后创面愈合时间［（43±9）min、（13.1±0.8）d］均明显短于螺旋桨皮瓣组［（87±16）min、（16.7±4.6）d， t值分别为-7.03、-2.86， P<0.05］。2组患者术后皮瓣成活、并发症情况均相近（ P>0.05）。结论对于手指掌侧创面的修复，蝶形皮瓣与传统螺旋桨皮瓣相比更具优势；蝶形皮瓣手术时间短，术后恢复快，值得临床推广。
- 外科皮瓣 /
- 指 /
- 修复外科手术 /
- 蝶形皮瓣 /
- 螺旋桨皮瓣
Abstract: Objective To compare the curative effects of butterfly-shaped flap based on the dorsal branch of digital artery (hereinafter referred to as butterfly-shaped flap) and propeller flap based on the dorsal branch of digital artery (hereinafter referred to as propeller flap) in repairing the wound in volar aspect of finger. Methods A retrospective cohort study was conducted. From August 2018 to April 2022, 16 patients with finger palmar wounds admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine and 7 patients with finger palmar wounds admitted to General Hospital of PLA Central Theater Command met the inclusion criteria, including 14 males and 9 females, aged 25 to 64 years. After debridement or resection of skin benign tumor, the wounds ranged from 0.5 cm×0.5 cm to 1.5 cm×1.5 cm. According to the different rotation axes of flap pedicle during wound repair, the patients were divided into butterfly-shaped flap group (8 cases) and propeller flap group (15 cases), and their wounds were repaired by butterfly-shaped flap (with area of 0.5 cm×0.5 cm-1.5 cm×1.3 cm) or propeller flap (with area of 0.7 cm×0.5 cm-1.5 cm×1.5 cm) , respectively. In propeller flap group, wounds in the donor sites were repaired by full-thickness skin grafts taken from the palms of wrists or the groin. The surgical time, postoperative complications, flap survival, and wound healing time of patients in the two groups were recorded. Data were statistically analyzed with independent sample t test, Mann Whitney U test, or Fisher's exact probability test. Results The surgical time and postoperative wound healing time of patients in butterfly-shaped flap group ((43±9) min and (13.1±0.8) d, respectively) were both significantly shorter than those in propeller flap group ((87±16) min and (16.7±4.6) d, respectively, with t values of -7.03 and -2.86, respectively, P<0.05). The postoperative flap survival and complications of patients between the two groups were both similar ( P>0.05). Conclusions For repairing the wound in volar aspect of finger, the butterfly-shaped flap has more advantages in comparison with the traditional propeller flap. The butterfly-shaped flap has a short surgical time and fast postoperative recovery, which is worthy of clinical promotion.
- Surgical flaps /
- Fingers /
- Reconstructive surgical procedures /
- Butterfly-shaped flap /
- Propeller flap
孙旭：酝酿和设计研究、采集资料、分析数据与撰写论文；殷宗琦：实施手术、采集资料、分析数据；郑捷新、窦懿、张勤：酝酿和设计研究、实施手术、分析数据、修改论文；付强：实施手术、采集资料、修改论文；张文龙：酝酿和设计研究、修改论文；易磊：酝酿和设计研究、实施手术、分析数据、修改论文、经费支持

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参考文献(15)

[1]	刘本立,陈铭锐,于仁义,等. 指固有动脉背侧支岛状皮瓣在手指热压伤修复中的临床应用分析[J]. 安徽医药,2015,19(7):1344-1345. DOI: 10.3969/j.issn.1009-6469.2015.07.036.
[2]	王辉,杨晓溪,王斌,等.吻合静脉的带蒂指动脉背侧支岛状皮瓣修复同指指端或指腹缺损的效果[J].中华烧伤杂志,2020,36(11):1065-1069.DOI: 10.3760/cma.j.cn501120-20191113-00427.
[3]	韩健,黄家菊,谢小军,等.应用指掌侧固有动脉终末背侧支岛状皮瓣联合甲床扩大修复儿童指端缺损28例[J].中华显微外科杂志,2021,44(1):104-105.DOI: 10.3760/cma.j.cn441206-20200126-00028.
[4]	RouletS, DelgoveA, ChirezP, et al. The homodigital propeller flap: a new tool for fingertip reconstruction. surgical technique, anatomical study, and clinical relevance[J]. Plast Reconstr Surg, 2022,149(2):413-418. DOI: 10.1097/PRS.0000000000008723.
[5]	HuHL,ChenH,HongJJ,et al.Propeller perforator flaps from the dorsal digital artery perforator chain for repairing soft tissue defects of the finger[J].BMC Surg,2019,19(1):188.DOI: 10.1186/s12893-019-0649-7.
[6]	DionyssiouD,PagkalosA,PapasA,et al.Evolution and refinements of a dorsal adipofascial digital artery perforator flap[J].Injury,2020,51 Suppl 4:S48-53.DOI: 10.1016/j.injury.2020.03.023.
[7]	MateiIR,BumbasirevicM,GeorgescuAV.Finger defect coverage with digital artery perforator flaps[J].Injury,2019,50 Suppl 5:S95-98.DOI: 10.1016/j.injury.2019.10.057.
[8]	ArikA,CevikK,ÖzcanyüzB.Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries[J].J Hand Surg Eur Vol,2021,46(8):865-872.DOI: 10.1177/17531934211015858.
[9]	张文龙,赵刚,高顺红,等.指固有动脉终末背侧支皮瓣修复指端缺损的显微解剖研究及临床应用[J].中华解剖与临床杂志,2015,20(5):418-422.DOI: 10.3760/cma.j.issn.2095-7041.2015.05.010.
[10]	王辉,杨晓溪,霍永鑫,等.同指指动脉背侧皮支血管链皮瓣逆行修复手指指端脱套伤[J].中国修复重建外科杂志,2020,34(5):669-670.DOI: 10.7507/1002-1892.201902021.
[11]	WinkJD,GandhiRA,AshleyB,et al.Flap reconstruction of the hand[J].Plast Reconstr Surg,2020,145(1):172e-183e.DOI: 10.1097/PRS.0000000000006311.
[12]	张健,黄剑,潘佳栋,等.拇手指再造的多组织移植术后血管危象探讨[J].中国修复重建外科杂志,2017,31(3):323-326.DOI: 10.7507/1002-1892.201611030.
[13]	谢松林,唐举玉,陶克奇,等. 指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的应用解剖[J]. 中国临床解剖学杂志,2010,28(1):97-100. DOI: 10.13418/j.issn.1001-165x.2010.01.030.
[14]	KohSH,ParkI,KimJS,et al.Fingertip reconstruction with a subcutaneous flap and composite graft composed of nail bed and volar pulp skin[J].Arch Plast Surg,2022,49(1):70-75.DOI: 10.5999/aps.2021.01200.
[15]	ChenC,TangPf,ZhangX.The dorsal homodigital island flap based on the dorsal branch of the digital artery: a review of 166 cases[J].Plast Reconstr Surg,2014,133(4):519e-529e.DOI: 10.1097/PRS.0000000000000016.

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1 基于指动脉背侧支供血的蝶形皮瓣设计示意图。1A.手指掌侧创面两侧微型三角形皮瓣设计及皮瓣的血供基础为指动脉背侧支；1B.手指掌侧、尺桡侧、背侧蝶形皮瓣标记及血供；1C.穿支血管蒂旋转修复创面方向，其中1指蝶形皮瓣水平面旋转，中间指矢状面、冠状面、水平面旋转，2指基于指动脉背侧支供血的螺旋桨皮瓣矢状面旋转

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2 采用基于指动脉背侧支供血的螺旋桨皮瓣修复例1患者右手中指掌侧创面。2A、2B.分别为术前右手中指远节近端掌侧灼伤致创面伴感染的正、侧位情况；2C.术前设计皮瓣并标记；2D.清创后示右手中指远节近端掌侧新鲜创面；2E.皮瓣旋转修复术中；2F.术后皮瓣静脉淤血，行蒂部部分拆线及放血治疗后淤血明显缓解；2G、2H.分别为术后20 d右手中指背侧供区创面正、侧位情况，可见创面愈合良好，外形稍肿胀

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3 采用基于指动脉背侧支供血的蝶形皮瓣修复例2患者右手中指掌侧创面。3A、3B.分别为术前右手中指近掌侧瘤样增生正、侧位情况；3C.术中切除瘤体后右手中指远节掌侧新鲜创面；3D、3E.分别为术中设计并标记皮瓣的右手中指桡侧面、尺侧面；3F.皮瓣旋转推进修复术中；3G、3H.分别为术后12 d右手中指远节掌侧切口愈合正、侧位情况，可见创面愈合良好，少许线状瘢痕，无肿胀

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表1 2组手指掌侧创面患者临床资料比较

组别	例数	性别（例）		年龄（岁， x ¯ ± s ）	清创或皮肤良性肿瘤切除术后创面面积［cm ²， M（ R）］	致伤原因（例）		受伤手指（个）
组别	例数	男	女	年龄（岁， x ¯ ± s ）	清创或皮肤良性肿瘤切除术后创面面积［cm ²， M（ R）］	烧/创伤	皮肤良性肿瘤切除术后	拇指	示指	中指	环指	小指
蝶形皮瓣组	8	5	3	45±14	0.48（0.31）	5	3	1	3	3	1	0
螺旋桨皮瓣组	15	9	6	48±12	0.36（0.70）	7	8	3	4	5	2	1
统计量值		—		t=-0.46	Z=-0.42	—		—
P值		0.633		0.647	0.681	0.389		0.920
注：蝶形皮瓣为基于指动脉背侧支供血的蝶形皮瓣，螺旋桨皮瓣为基于指动脉背侧支供血的螺旋桨皮瓣；“—”表示无此统计量值

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表2 2组手指掌侧创面患者疗效比较

组别	例数	手术时间（min， x ¯ ± s ）	静脉危象（例）		术后皮瓣成活（例）	术后创面愈合时间（d， x ¯ ± s ）
组别	例数	手术时间（min， x ¯ ± s ）	有	无	术后皮瓣成活（例）	术后创面愈合时间（d， x ¯ ± s ）
蝶形皮瓣组	8	43±9	0	8	8	13.1±0.8
螺旋桨皮瓣组	15	87±16	5	10	15	16.7±4.6
t值		-7.03	—		—	-2.86
P值		<0.001	0.089		1.000	0.012
注：蝶形皮瓣为基于指动脉背侧支供血的蝶形皮瓣，螺旋桨皮瓣为基于指动脉背侧支供血的螺旋桨皮瓣；“—”表示无此统计量值