上肢微型游离皮瓣修复外伤性手指创面112例

目的 分析上肢微型游离皮瓣修复外伤所致手指创面的手术方法及近期疗效.方法 选择224例手指外伤病例,采用随机数字表法分为观察组与对照组各112例,观察组应用上肢微型游离皮瓣修复手指创面,对照组应用腹部皮瓣修复手指创面.术后6个月比较两组的皮瓣存活情况、外形特征、感觉功能和手指活动情况.结果 两组病例皮瓣均全部成活.观察组成活良好率(93.80%)高于对照组(85.72%),差异有统计学意义(χ2=3.925,P=0.048).观察组皮瓣两点辨别觉(6.32 ± 1.14)mm,优于对照组(11.66 ±1.36)mm,差异有统计学意义(t=28.148,P<0.001).观察组综合质地觉优良率(86.61%)优于对照组(75.89%),差异有统计学意义(Z=-2.895,P=0.004).观察组手指功能恢复优良率(93.75%)高于对照组(86.71%),差异有统计学意义(Z=-2.592,P=0.010).观察组中不同种微型游离皮瓣修复后的手指活动功能差异无统计学意义(χ2=1.272,P=0.982).结论 上肢微型游离皮瓣移植修复手指创面近期疗效好,可以进一步临床推广.

Traumatic finger wound repaired by micro free flap of upper limb:112 cases

Objective To analyze the surgical method and the short-term curative effect of traumatic finger wound repaired by micro free flap of upper limb.Methods Two hundred and twenty-four cases with finger trauma were chosen and randomly assigned into ob -servation group(112 cases)and control group(112 cases).Cases in observation group were repaired by transplantation of micro free flap of upper limb,while cases in control group were repaired by abdominal flaps.The cases were given postoperative follow-up,and flaps survival,appearance characteristics,sensory function and finger activity were compared.Results All the flaps in two groups sur-vived.The excellent rate of observation group(93.80%)was higher than that of controls(85.72%),and the difference was statistical-ly significant(χ2=3.925,P=0.048).Mean for two-points discrimination of flaps in observation group was(6.32 ±1.14)mm,better than that of control group(11.66 ±1.36)mm,and the difference was statistically significant(t=28.148,P<0.001).The excellent rate of comprehensive sensation in observation group(86.61%)was superior to that of control group(75.89%),and the difference was statistically significant(Z=-2.895,P=0.004).The excellent rate of finger function recovery of observation group(93.75%) was higher than that of controls(86.71%),and the difference was statistically significant(Z=-2.592,P=0.010).The difference of finger function recovery in different subgroups of observation group was not statistically significant(χ2=1.272,P=0.982).Conclu-sions The traumatic finger wound repaired by the transplantation of micro free flap of upper limb can achieve satisfactory short -term effects,and can be further popularized.