改形设计指固有动脉岛状皮瓣修复复杂指端缺损的疗效

黄悦; 林枫; 郝春雨; 梁久龙; 周大鹏; 王洪一

doi:10.3760/cma.j.cn501225-20230109-00008

改形设计指固有动脉岛状皮瓣修复复杂指端缺损的疗效

doi: 10.3760/cma.j.cn501225-20230109-00008

北部战区总医院烧伤整形科，沈阳　　110016

基金项目:

国家自然科学基金青年科学基金项目 82002047

详细信息

通讯作者:
王洪一，Email：whyi87@163.com

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出版历程
- 收稿日期: 2023-01-09

Effects of modified proper digital artery island flap in repairing complex fingertip defects

Department of Burns and Plastic Surgery, General Hospital of Northern Theater Command, Shenyang 110016, China

Funds:

Youth Science Foundation Project of National Natural Science Foundation of China 82002047

More Information

Corresponding author: Wang Hongyi, Email: whyi87@163.com

摘要

摘要: 目的探讨采用改形设计的指固有动脉岛状皮瓣修复复杂指端缺损的手术方法及临床效果。方法采用回顾性观察性研究方法。2017年1月—2021年12月，北部战区总医院收治15例（15指）符合入选标准的累及指腹、甲床及甲侧壁的复杂指端缺损患者，其中男11例、女4例，年龄18~55岁。清创后创面面积为2.5 cm×2.0 cm~3.5 cm×3.5 cm，均采用改形设计的指固有动脉岛状皮瓣（包括主皮瓣、舌形皮瓣、三角形皮瓣3个部分）进行修复，其中主皮瓣用于覆盖指腹缺损，舌形皮瓣用于覆盖甲床及甲侧壁缺损，三角形皮瓣插入指腹创缘用于覆盖血管蒂。皮瓣切取范围为3.0 cm×2.0 cm~4.5 cm×3.0 cm。采用腹股沟区全厚皮片移植修复皮瓣供区，将皮片供区直接缝合。术后，观察皮瓣和皮片成活情况以及患指外形。随访时，观察患指指尖形态，测量患指指腹两点辨别觉距离，询问患者对疗效的满意度（包括非常满意、满意、不满意），并以美国手外科学会推荐的总主动活动度系统评定标准评定患指功能。结果术后，15例患者的主皮瓣及移植皮片均全部成活；1例患者的舌形皮瓣边缘切口愈合不良，1例患者的舌形皮瓣远端发生静脉淤滞；三角形皮瓣在术后早期略显臃肿，2~3个月后变平整；总体上，有2例患者皮瓣发生皮下血肿。所有皮瓣并发症经适当换药、拆线或加压包扎后逐渐治愈。术后，皮瓣外形饱满并形成突出的指端形态。术后随访6个月~5年，患指指尖突出、饱满，患指指腹两点辨别觉距离为（8.6±1.4）mm，对疗效非常满意者8例、满意者6例、不满意者1例，患指功能评定均为优。结论改形设计的指固有动脉岛状皮瓣可以修复累及指腹、甲床及甲侧壁的复杂指端缺损，手术方法简单，术后指尖形态及功能均良好。
- 显微外科手术 /
- 外科皮瓣 /
- 指固有动脉 /
- 岛状皮瓣 /
- 复杂指端缺损 /
- 创面修复
Abstract: Objective To investigate the surgical method and clinical effects of the modified proper digital artery island flap in repairing complex fingertip defects. Methods A retrospective observational study was conducted. From January 2017 to December 2021, 15 patients (15 fingers) with complex fingertip defects, involving the pulp, nail bed, and lateral wall of the nail, who met the inclusion criteria were admitted into General Hospital of Northern Theater Command, including 11 males and 4 females, aged from 18 to 55 years. The area of the post debridement wound was from 2.5 cm×2.0 cm to 3.5 cm×3.5 cm, and all the wounds were repaired by using modified proper digital artery island flap (including 3 parts: main flap, tongue-shaped flap, and triangular flap), of which the main flap was used to cover the finger pulp defect, the tongue-shaped flap was used to cover the nail bed and the nail lateral wall defect, and the triangular flap was inserted into the edge of the finger pulp wound to cover the vessel pedicle. The range of the flap ranged from 3.0 cm×2.0 cm to 4.5 cm×3.0 cm. The wound at the donor site was repaired with full-thickness skin graft of the groin, and the donor site of the skin graft was sutured directly. After operation, the survival of the flap and skin graft as well as and the appearance of the affected finger were observed. During the follow-up, the fingertip morphology of the affected finger was observed, two-point discrimination distance of the affected finger pulp was measured, and the patients' satisfaction with the efficacy (including very satisfied, satisfied, and dissatisfied) was asked, and the affected finger function was evaluated by the total active movement (TAM) system evaluation standard recommended by American Academy for Surgery of Hand. Results After operation, the main flaps and skin grafts in 15 patients all survived; but the incision at the edge of tongue-shaped flap in one patient healed poorly, and one patient developed venous stasis at the distal end of the tongue-shaped flap; the triangular flap at the pedicle was slightly bloated in the early postoperative period and became smooth after 2 to 3 months. Overall, two patients developed subcutaneous hematoma in their flaps. All the complications were healed by appropriate dressing change, suture removal, or compression bandaging. After operation, the appearance of the flap was full and formed a prominent fingertip shape. During the follow-up of 6 months to 5 years, the fingertips of the affected fingers were prominent and full; the two-point discrimination distance of the affected finger pulp was (8.6±1.4) mm; 8 patients were very satisfied with the efficacy, 6 patients were satisfied, and one patient was dissatisfied; the functional assessment of the affected fingers were all excellent. Conclusions The modified proper digital artery island flap can repair complex fingertip defects involving the pulp, nail bed, and lateral wall of the nail. The operation is simple, and the shape and function of the fingertip are good after surgery.
- Microsurgery /
- Surgical flaps /
- Proper digital artery /
- Island flap /
- Complex fingertip defect /
- Wound repair
黄悦：统计分析和论文撰写；林枫、郝春雨：数据采集；梁久龙、周大鹏：技术指导、行政支持；王洪一：研究指导、论文修改、经费支持

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1 改形指固有动脉岛状皮瓣修复患者右手示指指端离断再植术后指体坏死创面的效果。1A.再植指体坏死背侧外观及皮瓣设计，a区为主皮瓣，b区为舌形皮瓣，c区为三角形皮瓣；1B.再植指体坏死指腹侧外观；1C.对腹股沟全厚皮片供区行美容缝合；1D、1E、1F.分别为皮瓣转移后即刻患指背侧、指腹侧及桡侧外观；1G、1H、1I.分别为术后6个月，患指背侧、指腹侧及桡侧外观，指端形态饱满、外形良好

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