Clinical efficacy of the first dorsal metatarsal artery pedicled lateral toe bilobed flap in repairing the finger pulp defects of two adjacent fingers
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摘要:
目的 探讨采用以第1跖背动脉为蒂的趾侧分叶皮瓣修复相邻两指指腹缺损的临床效果。 方法 该研究为回顾性观察性研究。2018年1月—2022年12月,解放军联勤保障部队第988医院烧伤整形科收治9例符合入选标准的相邻两指指腹缺损患者,其中男6例、女3例,年龄26~48岁。受伤手指为示指和中指者5例、中指和环指者4例。清创后单个手指创面面积为1.2 cm×0.8 cm~3.2 cm×2.8 cm,采用以第1跖背动脉为蒂的趾侧分叶皮瓣修复相邻两指指腹缺损并行两指并指缝合,单个皮瓣切取面积为1.5 cm×1.0 cm~3.5 cm×3.0 cm。将皮瓣供区创面直接缝合或取腹股沟区全厚皮修复。术后3周行分指手术。术后观察皮瓣成活情况、血运及供区皮片成活情况、创面愈合情况。随访时观察皮瓣的质地、滑动性、外形和手指活动功能,以及足部供区外形及功能。末次随访时,参考英国医学研究会感觉评定标准进行皮瓣感觉评定,参考中华医学会手外科学会断指再植功能评定试用标准进行手功能评定。 结果 9例患者术后皮瓣全部成活,无血管危象发生,皮瓣质地柔软、外形良好。1例患者足趾移植皮片边缘部分坏死,经换药后创面愈合；其余8例患者足趾移植皮片全部成活,创面愈合良好。术后随访12~18个月,皮瓣质地柔软、弹性好、滑动性小、外形良好；手指活动功能正常；足部供区创面恢复好,无破溃及畸形,行走无影响。末次随访时,皮瓣感觉灵敏,其中8指皮瓣感觉达S3级、10指皮瓣感觉达S3+级,皮瓣两点辨别觉距离为9~13 mm；患指功能评分为85~95分,均为优。 结论 以第1跖背动脉为蒂的趾侧分叶皮瓣可同时修复相邻两指指腹缺损,术后患指外形、感觉、功能恢复良好,且对足部供区损伤较小,是临床较佳的修复相邻两指指腹缺损的方法之一。 Abstract:Objective To explore the clinical efficacy of the first dorsal metatarsal artery pedicled lateral toe bilobed flap in repairing the finger pulp defects of two adjacent fingers. Methods This study was a retrospective observational study. From January 2018 to December 2022, 9 patients with finger pulp defects in two adjacent fingers who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 988th Hospital of Joint Logistics Support Force of PLA, including 6 males and 3 females, aged 26 to 48 years. The injured fingers were the index finger and middle finger (5 cases) or the middle finger and ring finger (4 cases). After debridement, the wound area of a single finger ranged from 1.2 cm×0.8 cm to 3.2 cm×2.8 cm. The finger pulp defects of two adjacent fingers were repaired with the first dorsal metatarsal artery pedicled lateral toe bilobed flap, and the two adjacent fingers were sutured together. The area of single flap ranged from 1.5 cm×1.0 cm to 3.5 cm×3.0 cm. The wound in the flap donor site was sutured directly or repaired with full-thickness skin graft from the groin region. The finger separation surgery was performed 3 weeks after surgery. The survival and blood supply of flaps, and survival of skin grafts and wound healing of the donor sites were observed after surgery. During follow-up, the texture, sliding, and shape of the flap, movement function of the finger, and the shape and function of the foot donor site were observed. At the last follow-up, the sensory of the flap was evaluated according to the sensory evaluation standard of the British Medical Research Council, and the hand function was evaluated according to the functional evaluation trial standard for severed finger replantation of the Hand Surgery Society of the Chinese Medical Association. Results After surgery, all the flaps of 9 patients survived without vascular crisis. The flaps were soft in texture and good in shape. One patient had partial necrosis at the edge of the skin graft in the toe, and the wound healed after dressing change; the skin grafts in the toe in the other 8 patients survived, and the wounds healed well. During follow-up of 12 to 18 months after surgery, the flaps had soft texture, good elasticity, low sliding, and good shape. The finger movement function was normal. The wound in foot donor site recovered well without ulceration and deformity, and walking was not affected. At the last follow-up, the sensation of the flaps was sensitive, of which 8 flaps reached S3 and 10 flaps reached S3+ in sensation, and the two-point discrimination distance of the flaps was 9-13 mm. The functional scores of the affected fingers were 85 to 95, all of which were excellent. Conclusions The first dorsal metatarsal artery pedicled lateral toe bilobed flap can repair finger pulp defects of two adjacent fingers at the same time, and the appearance, sensation, and function of the affected fingers recovered well after surgery, with less damage to the foot donor site. It is one of good methods to repair finger pulp defects of two adjacent fingers in clinic. -
参考文献
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图 1 采用以第1跖背动脉为蒂的趾侧分叶皮瓣修复例1患者右手中指和环指指腹缺损的效果。1A.清创后右手中指、环指创面情况；1B.术中于右足𧿹趾腓侧及第2足趾胫侧设计皮瓣；1C.术中切取皮瓣,皮瓣断蒂前血运好；1D.用皮瓣覆盖右手中指、环指指腹创面并缝合后即刻,皮瓣血运良好；1E.术后12个月随访时,皮瓣存活良好,右手中指、环指指腹外观良好；1F.术后12个月随访时,足部供区恢复良好
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