Reconstruction of distal phalangeal injuries with the reverse homodigital island flap

Reconstruction of extensive distal phalangeal defects with exposure of tendon, bone, or joint can be particularly a difficult problem. For assessment of the value of the reverse homodigital island flap patients with distal phalangeal avulsion and crush injuries who were treated from January 2005 to April 2006 were analysed retrospectively. Main outcome measurements included flap survival rate, sensory restoration, occurrence of cold intolerance, length of occupational disability, and joint mobility. Eleven patients were included in the study. Only one patient suffered from venous congestion with partial flap necrosis, requiring debridement with subsequent skin grafting. The minimum follow-up was 6 months. The static 2-point discrimination had a mean value of 9 mm. None of our patients complained of cold intolerance or residual joint contracture. All patients returned to full occupational activity within an average time period of 4.5 weeks. In conclusion, the reverse homodigital island flap is an excellent option for 1-stage reconstruction of distal phalangeal defects.     

同指背侧转移皮瓣的临床应用

目的 介绍一种指端离断后以瓣转移重建指端的方法。方法 应用同指远侧指间关节背侧转移皮瓣修复指端离断26例28指。结果 随访3－16个月，所有皮瓣均成活，伤指残端都有指甲生长，远侧指间关节活动范围满意。结论 同指远侧指间关节背侧转移皮瓣是修复指离断的一种较好的方法，具有操作简单，手术速度快，创伤小，效果好等优点。     

指背逆行岛状筋膜蒂皮瓣修复指端皮肤软组织缺损

<正>指端是手指末节的一部分,有较灵敏的感觉。指端皮肤软组织缺损是手外科较常见的损伤,此类损伤常伴有骨、关节、肌腱等深层组织外露或损伤,常需行皮瓣修复。自1981年Pontén[1]发表筋膜皮瓣文章以来,筋膜蒂皮瓣在临床上得到广     

The adipofascial turn-over flap for coverage of the dorsum of the finger: a modified surgical technique

PURPOSE: The exact distances from the cutaneous dorsal branches of the digital artery to the proximal interphalangeal joint have been established in a previous anatomic study. The aim of this report is to incorporate these anatomic data into the current way of designing the homodigital adipofascial turn-over flap for cutaneous coverage of the dorsum of the finger. Our clinical experience with this modified surgical technique to this flap is reported. METHODS: The clinical series presented here consists of 40 patients with loss of cutaneous coverage at the dorsal aspect of the middle and distal phalanges. Based on our anatomic findings the flap was designed to include at least 1 dorsal branch in its pedicle. RESULTS: The flap survival was excellent and no donor site complications were observed. CONCLUSIONS: The adipofascial turn-over arterial flap has appeared as an excellent alternative for achieving early coverage of cutaneous wounds at the dorsal aspect of middle and distal phalanges of the long fingers. This flap can be designed as an arterial flap in a predictable and reliable way based on new anatomic data on the vascularization of the dorsum of the finger.     

两种手指逆行岛状皮瓣修复指远节软组织缺损的疗效比较

目的 分析两种手指逆行岛状皮瓣修复指远节软组织缺损的临床效果的异同、适应证和注意事项. 方法 从2000年1月至2008年7月,共收治500例514指远节软组织缺损,按照缺损面积分别采用同指侧方逆行岛状皮瓣(250例263指)和邻指侧方逆行岛状皮瓣(250例251指)修复.术后随访3～8年,比较两种皮瓣的修复范围、指蹼开大角度、皮瓣感觉等. 结果 500例514指皮瓣全部成活,术后随访按照皮瓣修复范围比较,邻指皮瓣(2.5 cm×5.0 cm)优于同指皮瓣(2.0 cm× 3.0 cm)(P＜0.05);按照指蹼开大角度(大于或等于30°)比较,同指皮瓣(229指)优于邻指皮瓣(166指)(P＜0.05);同指皮瓣的感觉恢复略好于邻指皮瓣(P＜0.05);按照远期效果比较,两者差异无统计学意义(P＞0.05). 结论 在手指远节小于2.0 cm× 2.5 cm软组织缺损,可选用同指皮瓣;超过2.0 cm×3.0cm软组织缺损,应选用邻指皮瓣.依据皮瓣修复面积首选邻指皮瓣;依据指蹼开大和感觉恢复首选同指皮瓣;依据手指灵活性,两种皮瓣均可.     

带指神经血管蒂的V - Y岛状推进皮瓣治疗指端皮肤缺损

目的 介绍应用带双侧或单侧指神经血管蒂的V-Y岛状推进皮瓣修复指端皮肤缺损的疗效。方法 对86例102指指端皮肤缺损患者,设计并采用带双侧或单侧指神经血管蒂的V-Y岛状推进皮瓣修复创面。对指端偏背侧、横截面及缺损长度<1.2 cm的偏掌侧皮肤缺损,用双蒂岛状皮瓣修复;对缺损长度在1.2～2 cm的偏掌侧皮肤缺损,用单蒂岛状皮瓣修复。结果 皮瓣全部成活。20指失访,82指术后平均随访13个月。皮瓣覆盖质量满直,指腹二点分辨觉均在正常范围内,但有2指产生残端神经痛。77指冷天皮瓣能耐寒冷皮温正常,5例5指因皮瓣耐寒性差而影响工作。指间关节活动范围基本正常。结论 该皮瓣较传统的V-Y皮瓣具有手术简单、术后外形好、感觉正常、关节活动不受影响等优点;是修复指端皮肤缺损的有效方法之一。     

拇指软组织缺损的本体皮瓣修复

目的探讨应用拇指本体皮瓣对拇指软组织缺损修复的有效方法。方法应用三种不同的拇指本体皮瓣,即Hueston皮瓣,Moberg皮瓣及拇指尺背侧动脉逆行皮瓣修复10例拇指软组织缺损的患者。结果皮瓣全部成活,外形修复理想,受创拇指的长度得到保留,拇指感觉存在。结论对于拇指软组织缺损,尤其合并多指损伤时,应用同指本体皮瓣,完成对裸露骨组织的覆盖,可避免受创拇指有效长度的进一步缩短和恢复理想的感觉,操作简单、手术效果满意。     

带神经的同指螺旋状顺行岛状皮瓣修复指端缺损

目的 探讨带神经的同指螺旋状顺行岛状皮瓣修复指端缺损的手术效果.方法 2007年3月至2009年6月,对15例指端缺损的患者,在清创术后3～6 d,采用带神经的同指螺旋状顺行岛状皮瓣进行修复.指端皮肤缺损面积为1.5 cn×1.2 cm～2.2 cm×2.0 cm.供区中节指背创面取前臂内侧全厚皮片植皮修复.结果 术后15例皮瓣均未发生血管危象,皮瓣与皮片全部存活.15例随访时间为6～24个月,患指伸、屈功能正常,伤指无疼痛,皮瓣外形满意、质地柔软、有指纹,末节指端静止两点分辨觉为5～6 mm,指侧方静止两点分辨觉为8～10 mm.结论 带神经的同指螺旋状顺行岛状皮瓣修复指端缺损,手术方法简单、可靠,效果满意,是修复指端缺损的一种理想的手术方法.     

急诊应用V-Y推进皮瓣修复指端组织缺损

正2010年2月~2015年2月,我科应用V-Y推进皮瓣急诊修复134例指端软组织缺损患者,效果良好,报道如下。1材料与方法1.1病例资料本组134例(144指),男102例(110指),女32例(34指),年龄18~55岁。其中拇指34指,示指33指,中指31指,环指24指,小指22指。食指、中指均受伤者4例,中指、环指均受伤者2例,食指、中指、环指均受伤者     

Reversed cross finger subcutaneous flap: A rapid way to cover finger defects

Adequate coverage of dorsal finger wounds is often a challenge. The reversed cross finger subcutaneous flap to cover defects on the dorsum of phalanx constitutes an excellent option for coverage of wounds over the middle and distal phalanges of the index, middle, ring, and small fingers. It''s an easy flap and represents our first choice to cover those defects.     

指动脉逆行岛状皮瓣修复指腹缺损

目的:报道应用吻合指固有神经背侧支的指动脉逆行岛状皮瓣修复指腹缺损的临床效果。方法:对20例末节指腹缺损的患者应用吻合指固有神经背侧支的指动脉逆行岛状皮瓣修复,皮瓣切取面积1.8cm×2.0cm～3.0cm×3.5cm。结果:20例皮瓣全部成活,术后随访6～12个月,伤指外形与正常指接近,指腹饱满。两点分辨率在6～8cm。结论:应用吻合指固有神经背侧支的指动脉逆行岛状皮瓣,术后效果较好,供区损伤小,是修复末节指腹缺损的较理想的手术方法。     

双蒂掌背动脉逆行皮瓣治疗手指末节脱套伤

目的 探讨双蒂掌背动脉逆行皮瓣治疗手指末节脱套伤的方法.方法 2005年1月至2008年3月,对28例28指末节脱套伤患者,应用双蒂掌背动脉逆行皮瓣修复,其中示指10指,中指13指,环指5指,缺损平面均在远侧指问关节以远,脱套末节长度0.8～2.2 cm.急诊手术24指,末节皮肤坏死二期手术4指.结果 28例28指皮瓣.除3例皮瓣远端部分张力性水泡形成表皮坏死结痴经换药愈合外,余全部成活.25例经4～27个月随访,外形、感觉和功能恢复满意,静态两点辨距觉达6.0～9.0 mm,平均7.6 mm.结论 双蒂掌背动脉逆行皮瓣治疗手指末节脱套伤,手术简便、安全,疗程短,效果满意.     

指固有动脉串联岛状皮瓣修复相邻指体指端套脱伤

目的 研究采用指固有动脉串联逆行岛状皮瓣修复相邻指体指端套脱伤的临床疗效.方法 2009年3月至2011年5月,我院采用指固有动脉串联逆行岛状皮瓣修复相邻指体指端套脱伤11例.示指5例,中指3例,环指2例,小指1例.皮肤缺损面积为3.0 cm×2.2 cm～5.5 cm×4.5 cm.结果 本组1例术中皮瓣在游离过程中即发生血管痉挛,经局部滴注罂粟碱及生理盐水热敷后痉挛解除;2例皮瓣术后出现水泡,1周后消失;其余皮瓣均顺利存活.术后随访6～24个月,平均12个月.皮瓣外形、质地均良好,恢复部分感觉功能.参照中华医学会手外科学会上肢部分功能评定试用标准评定:优6例,良4例,可1例;优良率90.9％.结论 指固有动脉串联逆行岛状皮瓣修复指端套脱伤,手术操作简便,疗效满意.     

顺行岛状皮瓣与甲床回植术治疗指尖离断伤

目的探讨急诊采用顺行岛状皮瓣与甲床回植治疗指尖离断伤的显微修复方法。方法对10例指尖离断伤的患者,急诊采用顺行岛状皮瓣与甲床回植进行显微修复。指尖离断平面分别位于甲中及甲根部平面。结果术后10例皮瓣和回植甲床均全部存活,术后随访时间为6～12个月。指端外观满意,皮瓣质地柔软,手指无明显触痛,活动功能正常。术后指甲较术前平均延长4．0～6．0mm,其中指甲与甲床完全附着8例,4／5附着2例。9例指甲光滑、无压痛,1例出现钩甲畸形。结论对甲根以远指尖离断无再植条件者,采用顺行岛状皮瓣修复手指残端,可保留手指的长度;将游离甲床回植,并加压包扎,可修复部分甲床,改善手指远端的外形。     

不同构制的(足母)甲瓣修复手指套脱伤

目的 探讨采用不同构制的(足母)甲瓣修复各种类型手指套脱伤的最佳术式.方法 本组选用部分(足母)甲瓣修复手指近侧指间关节以远完全撕脱(Ⅰ型套脱伤)5例7指;选用带足背皮瓣的部分(足母)甲瓣及第二趾侧腹皮瓣修复手指指根部完全撕脱(Ⅱ型套脱伤)7例11指.结果 12例18指全部成活,其中1例术后4 h发生(足母)甲瓣动脉危象,考虑为血管蒂受压,在指根部拆除部分缝线后血管危象缓解,(足母)甲瓣存活.受区伤口Ⅰ期愈合10例.Ⅱ期愈合2例,其中1例双侧(足母)甲瓣及第二趾侧腹皮瓣修复示、中指,中指中节指骨感染后骨坏死,作指骨摘除,3个月后伤口愈合;1例发生血管危象,指蹼处伤口不愈,经换药、植皮后3个月伤口愈合.供区植皮全部成活,Ⅰ期愈合9例,Ⅱ期愈合3例.术后随访时间为3～12个月,掌指关节活动度为0°～(60°～70°),近侧指间关节活动度为0°～(40°～50°),远侧指间关节活动度为0°;指腹饱满,两点分辨觉为8～12 mm.指甲生长良好9例;3例指甲有增厚,其中2例指甲生长偏斜.供区行走良好,无疼痛.结论 针对不同类型的手指套脱伤采用不同构制的(足母)甲瓣修复,既可达到满意的手功能,又可获得良好的手外形,是修复手指套脱伤的最佳术式.     

Complications of the reverse homodigital island flap in fingertip reconstruction

Twenty-four digital artery island flaps with reversed flow were used to reconstruct 23 patients with fingertip injuries in the authors' clinic between June 1998 and August 2000. No nerve coaptation was performed in these patients. Patient age ranged between 18 and 35 years. All patients were evaluated at clinical follow-up for active range of motion, appearance, patient satisfaction, two-point discrimination, hypersensitivity and cold intolerance, previous hand injury, and flap viability in the repaired finger. Based on their experience, the authors consider that this procedure has several disadvantages: relatively high flap loss, sacrifice of one of the two major arteries of the finger, it is a time-consuming method, it is a difficult flap dissection, there is a requirement for loupe and microsurgical equipment. The authors think that this flap should not be the first choice for fingertip reconstruction especially for patients who have possibility of reinjuring their hands because of their jobs.     

Reconstruction of distal foot wounds with reverse first dorsal metatarsal artery flap

Reconstruction of the distal portion of the foot has always represented a difficult problem in plastic surgery. We report a distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to treat the distal portion of the foot in eight patients. The size of flaps ranged from 3 cm × 4 cm to 6 cm × 7 cm. In seven patients, the transferred flaps survived completely and in one flap there was superficial marginal necrosis. There was no donor site morbidity. All the patients had no difficulty in wearing shoes and were walking within 6 weeks. We suggest that the reverse first dorsal metatarsal artery flaps is a good option to reconstruct the wound of distal foot.     

同指螺旋岛状皮瓣修复指腹缺损

目的：探讨同指螺旋岛状皮瓣修复指腹缺损的方法和临床疗效。方法：自2007年6月至2009年10月,采用以同指一侧指固有神经血管柬为蒂螺旋岛状皮瓣向前推进修复指腹缺损16例16指,男12例,女4例;年龄18～49岁,平均37岁。机器挤伤11例,重物砸伤2例,车门挤伤1例,电锯伤2例。损伤指别：食指5例．中指9例,环指2例。均为全指腹缺损,缺损范围：1．6cm×1．2cm-2．5cm×1．7cm,指背供区植皮。结果：皮瓣全部成活,创面I期愈合,全部病例均获随访,时间8-20个月,平均12个月,手指外形良好,皮瓣质地软,静止两点辨别觉为5～7mm,平均为5．1mm。按照手指总主动活动度评级标准（TAM）,优7例,良8例,中1例。结论：采用同指螺旋岛状皮瓣修复指腹缺损,手术操作简便,可获得良好临床疗效。     

带指动脉神经指背岛状皮瓣修复指端缺损

目的 探讨带指动脉神经的指背岛状皮瓣修复指端缺损的方法和疗效.方法 2011年6月至2012年9月,对15例18指指端皮肤缺损患者,以一侧指固有动脉神经背侧支为营养支,于远指间关节背侧设计皮瓣,带一侧指动脉神经,皮瓣旋转90°修复指端皮肤缺损,指背供区取上臂全厚皮片游离植皮.皮瓣携带指固有神经背侧支重建感觉.结果 术后15例18指皮瓣均存活.随访时间为6～ 12个月,皮瓣质地外观良好,感觉恢复至S～S4,两点分辨觉为4～8mm,患指指间关节主动活动度恢复优良.结论 采用指动脉神经的指背岛状皮瓣修复指端缺损,操作简单,不牺牲指固有动脉、神经,血供可靠,供区损伤小,并能重建感觉,是一种修复指端缺损的理想方法.     

下腹部真皮下血管网皮管修复手指皮肤脱套伤

目的：探讨下腹部真皮下血管肉皮管修复手指皮肤脱套伤。方法蒂傍于腹壁浅或旋髂浅血管部们 真皮下血管网皮瓣缝合为皮管，套于清创后伤指上，皮缘间断缝合；供瓣创面直接缝合。若两指同时受伤，将皮瓣一分为二，缝为皮管修复。修复１７只手１９指，皮瓣面积最小４．５ｃｍ＊４．５ｃｍ，最大８ｃｍ＊１３ｃｍ、蒂宽８ｃｍ。结果断蒂时间平均１８天，皮管全部成活。伤指皮肤３个月后出现感觉，结论该皮管修复脱套伤，术后伤指外形及