Repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger
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摘要: 目的 探讨患指锯齿状指固有动脉神经蒂皮瓣联合双皮下蒂V-Y推进皮瓣修复同指指端皮肤软组织缺损的治疗效果。 方法 2013年9月—2015年1月,笔者单位收治手指远端皮肤软组织缺损患者13例共13指。扩创后患指创面面积为1.2 cm×0.8 cm~1.8 cm×1.5 cm,采用同指锯齿状指固有动脉神经蒂皮瓣联合双皮下蒂V-Y推进皮瓣修复创面,皮瓣间断缝合。双皮下蒂V-Y推进皮瓣及同指锯齿状指固有动脉神经蒂皮瓣切取面积分别为0.52~1.11、2.60~5.23 cm2。 结果 13例患者皮瓣术后全部成活,获随访6~24个月。皮瓣色泽、质地良好;重建后指端呈弧形,手指外观与正常手指一致,跨关节切口关节活动正常;均未出现钩甲畸形、关节活动障碍等并发症。13例皮瓣感觉恢复达S4级,两点辨别觉距离2~3 mm,手指各关节运动功能恢复情况为优。 结论 患指锯齿状指固有动脉神经蒂皮瓣联合双皮下蒂V-Y推进皮瓣修复同指指端皮肤软组织缺损,血供可靠、操作简单,可以避免直线瘢痕挛缩畸形并且能够获得良好的外观及功能。Abstract: Objective To investigate the therapeutic effects of repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger. Methods Thirteen patients with skin and soft tissue defects at distal end of 13 fingers were hospitalized from September 2013 to January 2015. After debridement, the wound area of finger ranged from 1.2 cm×0.8 cm to 1.8 cm×1.5 cm. Serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger were used to repair the defect. The flaps were interruptedly sutured. The areas of bilaterally pedicled V-Y advancement flap and serrated flap with digital proper artery and nerve pedicle ranged from 0.52 to 1.11 and 2.60 to 5.23 cm2, respectively. Results All flaps of 13 patients survived completely. The patients were followed up for 6 to 24 months. The color and texture of the flaps were good. After reconstruction, the finger tips were in round in shape. The appearance of the fingers was consistent with that of the normal fingers, and joint motility was normal. No hook-nail deformity or knuckle dysfunction was found. Sensation of the flaps was estimated as S4, and the distance of two-point discrimination ranged from 2 to 3 mm. The recovery of the joint motion function of the fingers was excellent. Conclusions Serrated flap with digital proper artery and nerve pedicle, combined with bilaterally pedicled V-Y advancement flap from the injured finger can repair the skin and soft tissue defects at distal end of finger with reliable blood supply and simple operative technic. It also could avoid the formation of deformity subsequent to a linear scar, and a satisfactory appearance with good function could be obtained.
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Key words:
- Surgical flaps /
- Hand /
- Soft tissue injuries /
- Wound repair
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