Efficacy observation on repair of finger pulp defects and sensory reconstruction of children with the perforator propeller flaps based on the end dorsal branch of digital proper artery in the same finger
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摘要: 目的 探讨采用同指指固有动脉终末背侧支穿支螺旋桨皮瓣修复儿童指腹缺损并重建感觉的效果。 方法 2012年9月–2013年12月,笔者单位收治23例31指(累及示、中、环、小指)指腹缺损患儿。指腹缺损面积为1.2 cm×1.0 cm~2.0 cm×1.5 cm,应用同指指固有动脉终末背侧支穿支螺旋桨皮瓣进行修复,皮瓣切取面积为1.3 cm×1.2 cm~2.2 cm×1.6 cm。皮瓣内携带的指固有神经背侧支与指腹创面内指固有神经断端行端端吻合重建指腹感觉,皮瓣供区采用自体大腿内侧全厚皮片修复。 结果 术后23例患儿创面均愈合,皮瓣、供区植皮均成活。术后随访6~20个月,平均14个月。皮瓣及其供区外形恢复良好,指腹饱满圆润,未见明显色素沉着或瘢痕。指腹感觉恢复达S3+;两点辨别觉距离为4.5~6.0 mm,平均5.1 mm。患儿家长对术后手指外观非常满意21例、满意2例。 结论 儿童示、中、环、小指指腹缺损采用同指指固有动脉终末背侧支穿支螺旋桨皮瓣进行修复并重建指腹感觉,其手术方法安全可靠,皮瓣血运好,术后外形及感觉恢复良好。Abstract: Objective To investigate the clinical outcomes of the use of the perforator propeller flaps based on the end dorsal branch of digital proper artery in the same finger in repair of finger pulp defects and sensory reconstruction in children. Methods Twenty-three children (31 fingers) with index, middle, ring or little finger pulp defects were hospitalized from September 2012 to December 2013. The area of finger pulp defects ranged from 1.2 cm×1.0 cm to 2.0 cm×1.5 cm. The perforator propeller flaps based on the end dorsal branch of digital proper artery in the same finger were used to repair the defects, with the flap size ranging from 1.3 cm×1.2 cm to 2.2 cm×1.6 cm. The dorsal branch of the digital proper nerve of the flap was conducted end-to-end anastomosis with the broken end of the nerve of the wound to reconstruct sensation. The donor sites were covered with autologous full-thickness skin obtained from inner aspect of the thigh. Results Primary healing of the wounds and donor sites were achieved in all 23 children. All the flaps and skin grafts of donor sites survived. All the patients were followed up for 6 to 20 months, with mean time of 14 months. At the last follow-up, the flaps and donor sites were in good appearance, the finger pulps were mellow and plump, with no obvious pigmentation or cicatricial contracture. The sensation of finger pulps reached S3+, and the distance of two-point discrimination ranged from 4.5 to 6.0 mm, with mean distance of 5.1 mm. Twenty-one parents of the patients were strongly satisfied with the appearance of the repaired fingers, and the other 2 parents also expressed satisfaction. Conclusions Transplantation of the perforator propeller flap based on the end dorsal branch of digital proper artery in the same finger is a safe and reliable method for the repair of index, middle, ring, and little finger pulp defects and sensory reconstruction of children. The flaps are with good blood supply, appearance and sensory function after operation.
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