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

计量
- 文章访问数: 1055
- HTML全文浏览量: 38
- PDF下载量: 25
- 被引次数: 0
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

所有作者均声明不存在利益冲突

HTML全文

参考文献(27)

[1]	刘敏峰,朱文华,梅远东,等.第二趾甲瓣在指端组织缺损美学修复中的应用[J].中华手外科杂志,2007,23(5):313.DOI: 10.3760/cma.j.issn.1005-054X.2007.05.024.
[2]	AdaniR, TangJB, ElliotD. Soft and tissue repair of the hand and digital reconstruction[J]. J Hand Surg Eur Vol, 2022, 47(1):89-97.DOI: 10.1177/17531934211051303.
[3]	郑竞舟,邓名山,付志勇,等.应用显微外科技术游离踇甲瓣移植修复拇指皮肤缺损的临床研究[J].中国现代医药杂志,2021,23(11):28-30. DOI: 10.3969/j.issn.l672-9463.2021.11.007.
[4]	顾玉东.指部皮肤缺损的修复原则[J].中华手外科杂志,2012,28(3):130.DOI: 10.3760/cma.j.issn.1005-054X.2012.03.002.
[5]	刘小智,张晓童,宋坤修,等.游离踇甲瓣在拇、示指指端缺损再造中的应用[J].实用手外科杂志,2023,37(1):41-43.DOI: 10.3969/j.issn.1671-2722.2023.01.012.
[6]	田胜,刘振利,宿晓雷,等.以指固有动脉为蒂的手指侧方皮瓣结合甲床扩大术修复手指远端组织缺损[J].实用手外科杂志,2018,32(3):368-369.DOI: 10.3969/j.issn.1671-2722.2018.03.042.
[7]	郑颂耀,翁丽荣,李展新,等.指侧方血管链皮瓣连远端皮下筋膜瓣修复指端缺损伴部分甲床缺损[J].实用手外科杂志,2019,33(3):339-341.DOI: 10.3969/j.issn.1671-2722.2019.03.026.
[8]	吴林明,陈银兵,严纯,等.改良V-Y推进皮瓣修复指端缺损50例效果观察[J].交通医学,2022,36(1):72-73.DOI: 10.19767/j.cnki.32-1412.2022.01.019.
[9]	李木子.指动脉岛状皮瓣和邻指皮瓣治疗指端缺损的效果对比[J].中国现代药物应用,2020,14(18):107-108.DOI: 10.14164/j.cnki.cn11-5581/r.2020.18.047.
[10]	WangS, YuanC, DingW, et al. Repair of finger pulp defect and sensory reconstruction using reverse homodigital artery island flap with palmar cutaneous branches of the proper digital nerve[J]. Ann Plast Surg, 2023,90(6):559-563.DOI: 10.1097/SAP.0000000000003591.
[11]	DağdelenD, AksoyAK. Evaluation of neurotized hypothenar free perforator flaps used for fingertip reconstruction[J]. Ann Plast Surg,2020,84(2):e1-e6.DOI: 10.1097/SAP.0000000000001973.
[12]	Mendame EhyaRE, BoundaG, XiaoW, et al. Clinical effectiveness of dorsal branch skin flap of proper palmar digital artery with distal pedicle in repairing of fingertip soft tissue defect: a 1-year prospective study in a Chinese tertiary referral teaching hospital[J]. J and Surg Asian Pac Vol,2021,26(2):265-273. DOI: 10.1142/S2424835521500272.
[13]	XiongX, XuM, ShuaiM, et al. Comparative study of the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps for fingertip reconstruction[J]. Ann Plast Surg, 2021, 88(4):395-400.DOI: 10.1097/SAP.0000000000002967.
[14]	程邦君,尹占奇,郑兆宽,等.两种岛状皮瓣修复手指远节末端皮肤缺损的疗效比较[J].临床骨科杂志,2021,24(2):232-235.DOI: 10.3969/j.issn.1008-0287.2021.02.024.
[15]	梁好,陈莹恩,黎丹东,等. 携带指固有神经直接小分支的指动脉逆行岛状皮瓣修复指端缺损[J].中华手外科杂志,2018, 34(2):147-148.DOI: 10.3760/cma.j.issn.1005-054X.2018.02.026.
[16]	谭志伟,冯经旺,郑佐慧,等.保留指神经的指动脉逆行岛状皮瓣修复指端缺损的临床效果 [J] .中国伤残医学,2012,20(8):51-52.DOI: 10.3969/j.issn.1673-6567.2012.08.033.
[17]	苗杰.保留与不保留指神经的指动脉逆行岛状皮瓣修复指端缺损比较[J/CD].中西医结合心血管病电子杂志,2016,4(36):69-70.DOI: 10.3969/j.issn.2095-6681.2016.36.055.
[18]	刘军.改良指背筋膜蒂岛状皮瓣治疗指端皮肤缺损的临床疗效分析[J].创伤外科杂志,2019,21(3):228-229.DOI: 10.3969/j.issn.1009-4237.2019.03.018.
[19]	张军,边云龙,任建昕,等.带指固有神经背侧支的顺行指动脉岛状皮瓣修复拇指指腹缺损的临床研究[J].中国药物与临床,2021,21(20):3409-3410.DOI: 10.11655/zgywylc2021.20.019.
[20]	张兴奎,李文涛,张桂红,等.游离尺动脉腕上支Flow-through皮瓣修复手指皮肤软组织伴动脉缺损[J].实用手外科杂志,2021,35(3):342-344.DOI: 10.3969/j.issn.1671-2722.2021.03.022.
[21]	王进,赵光勋,胡沣,等.带部分趾甲的踇趾腓侧瓣修复手指末端软组织合并甲床缺损12例[J].中华显微外科杂志,2019,42(2):117-119.DOI: 10.3760/cma.j.issn.1001-2036.2019.02.004.
[22]	沈永辉,万绍乐,蔡森. 游离踇甲皮瓣移植在重建甲床及指尖缺损中的应用[J].中国医师杂志,2023, 25(3):402-405,410.DOI: 10.3760/cma.j.cn431274-20220623-00591.
[23]	薛继东,狄海萍,梁琰,等.足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面的疗效[J]. 中华烧伤与创面修复杂志,2023,39(8):724-730. DOI: 10.3760/cma.j.cn501225-20230323-00094.
[24]	宋杰,杨胜相,程栋,等.游离第二足趾急诊再造拇手指缺损的临床应用[J].中国美容整形外科杂志,2022,33(7):388-390.DOI: 10.3969/j.issn.1673-7040.2022.07.002.
[25]	王洪一,周南,宋昨非,等.中国赴马里维和二级医院手术病例分析[J].东南国防医药,2018,20(4):442-445.DOI: 10.3969/j.issn.1672-271X.2018.04.028.
[26]	方杰,高远,马可,等.指固有动脉背侧支皮瓣[J].中华解剖与临床杂志,2021,26(5):602-604.DOI: 10.3760/cma.j.cn101202-20210127-00025.
[27]	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.

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片