Local composite neurovascular island flap for skin cover in pulp loss of the thumb.

A local composite neurovascular island flap to provide stable skin cover with good soft tissue padding and sensibility for extensive pulp loss of the thumb was used in five patients. The island flap included the dorsoradial branches of the radial digital neurovascular bundle of the thumb.     

大鱼际远近端逆行岛状皮瓣修复拇指软组织缺损的临床应用

目的总结大鱼际远、近端逆行岛状皮瓣在修复拇指软组织缺损中的临床应用。方法根据拇指掌、背侧软组织缺损的不同部位,采用大鱼际逆行远端岛状皮瓣修复17例,大鱼际逆行近端岛状皮瓣修复5例。结果术后22例皮瓣全部存活,供、受区伤口均Ⅰ期愈合。术后20例获得9～18个月的随访,2例失访。皮瓣弹性、色泽良好,两点分辨觉为7～10mm。拇指功能恢复优16例,良3例,中1例,优良率达95％。供区大鱼际处留有瘢痕,拇对掌功能无影响。结论大鱼际远、近端逆行岛状皮瓣可满足拇指大部分软组织缺损的修复需要。     

Evaluation of moving and static two point discriminations of volar forearm skin before and after transfer as a sensate radial forearm island flap in reconstruction of degloving injury of the thumb.

In degloving injury of the thumb the large skin defect needs cover with sensate, glabrous and pliable skin. Although coverage of this defect with a sensate free flap from the foot is the best choice, most commonly, cover is achieved using a non-sensate distant pedicle flap. Between 2001 and 2003, degloving injuries of the thumb in eight patients were reconstructed using a sensate radial forearm flap in the sensory territory of the lateral ante-brachial nerve of the forearm which was repaired to the digital nerve of the thumb (six cases) or to a branch of the sensory radial nerve (two cases). Follow-up period ranged from 17 to 41 months (mean: 29.9 months). Sensory evaluation was performed using the moving two point discrimination (M-2PD) and static two point discrimination (S-2PD) of the volar forearm skin. These altered significantly after transfer and their values approached those of the contra-lateral thumb but never reached normal sensation (p<0.01). Sensate radial forearm island flap is a reliable option to cover a large defect of the thumb such as degloving injury and the sensation produced is acceptable.     

拇指背侧皮神经营养血管蒂岛状皮瓣修复拇指指端缺损

目的探讨拇指背侧带皮神经营养血管蒂岛状皮瓣修复拇指指端缺损的临床效果。方法利用带拇指桡背侧或尺背侧皮神经营养血管蒂岛状皮瓣修复拇指指端软组织缺损12例。结果12例皮瓣全部成活,经6～24个月随访,拇指外形和功能恢复良好。结论拇指背侧皮神经营养血管蒂岛状皮瓣具有操作简单、成活率高、外形恢复满意等优点,是修复拇指指端缺损的理想方法。     

Reverse-flow island flap from the thenar area of the hand

A reverse-flow island flap from the thenar eminence of the hand was applied in six patients to treat palmar skin defects, and amputation injuries of the thumb. There was one female and five males, and the patients' ages at the time of surgery averaged 48 years. A 3 x 2 to 5 x 3.5-cm fasciocutaneous flap from the radial aspect of the thenar eminence, located over the abductor pollicis brevis muscle, was designed and transferred in a retrograde fashion, to cover skin and soft-tissue defects of the thumb. The flap was based on the superficial palmar branch of the radial artery and, in three patients, was made sensate by the palmar branch of the superficial radial nerve. Follow-up periods averaged 61 months. The postoperative course was uneventful, and all the flaps survived without significant complications. The donor site was primarily closed in five patients, and one patient required flap coverage. A reverse island flap from the thenar area is easily elevated, contains durable fasciocutaneous structures, and has good color and texture, matching to the finger pulp. This flap offers a good alternative for reconstruction of palmar skin and soft-tissue defects of the thumb in selected patients.     

拇指桡背侧皮神经营养皮瓣修复拇指皮肤软组织缺损

目的探讨拇指背桡侧皮神经营养血管蒂的岛状皮瓣修复拇指软组织缺损的临床效果。方法对19例拇指软组织缺损患者利用拇指背桡侧皮神经营养血管皮瓣修复,其中修复感觉神经15例。缺损面积：1.5cm×1.0cm～2.5cm×2.5cm;皮瓣面积：2.0cm×1.5cm～3.0cm×2.5cm。结果19例皮瓣全部成活。随访5～30个月,皮瓣外观及感觉良好,指腹两点分辨觉为6～10mm。指间关节活动范围0°～80°。结论该皮神经皮瓣手术操作简单,皮瓣外形好,部分皮瓣能恢复感觉,是修复拇指软组织缺损的理想方法。     

One-stage reconstruction of the thumb using an osteo-cutaneous radial artery forearm flap

Summary One stage reconstruction of the thumb, with a satisfactory functional result, is described using an osteo-cutaneous radial artery forearm island flap.     

示指背侧皮瓣与趾腓侧皮瓣瓦合修复拇指套脱伤

目的 介绍应用示指背侧岛状皮瓣与游离趾腓侧皮瓣瓦合修复拇指套脱伤的临床方法.方法 对9例残留甲床的拇指套脱伤患者,采用示指背侧岛状皮瓣与趾腓侧游离皮瓣瓦合进行修复.结果 术后9例拇指瓦合皮瓣全部存活,随访时间为6个月至3年,皮瓣颜色、质地良好,拇指指甲生长良好,外形和功能满意,皮瓣两点分辨觉为8～10mm.供区示指及足趾植皮区愈合良好,无明显功能影响.结论 示指背侧岛状皮瓣与游离趾腓侧皮瓣瓦合修复是治疗残留甲床的拇指套脱伤的一种较好方法.     

食指背岛状皮瓣修复拇指末节损伤

目的探讨用食指背侧岛状皮瓣转移修复拇指末节损伤的效果。方法采用同侧带血管或筋膜蒂食指背侧岛状皮瓣转移修复拇指末节软组织缺损12例。结果12例均得到随访,时间1年6个月～7年,皮瓣全部成活,修复后的拇指既保留了长度,又保存了感觉和运动功能,且外形满意。结论用食指背侧岛状皮瓣转移修复拇指末节损伤是一种有效安全的手术方法,技术难度不大,所需器械简单,具有临床实用价值。     

第1掌骨背桡侧动脉蒂岛状皮瓣的临床应用

目的探讨第1掌骨背桡侧动脉岛状皮瓣在拇指远端软组织缺损修复中的临床应用。方法应用第1掌骨背桡侧动脉岛状皮瓣修复拇指远端软组织缺损20例。结果本组20例皮瓣全部成活．术后随访3-12个月,拇指外形满意,质地柔软,皮神经修复者两点辨别觉8～12mm。结论第1掌骨背桡侧动脉岛状皮瓣具有操作简便、质地良好、血供可靠、损伤小等优点,是修复拇指远端软组织缺损的较好方法。     

六种皮瓣修复拇指腹缺损的远期疗效观察

目的评价6种皮瓣修复拇指腹缺损的远期疗效.方法对2001年12月前,在我科接受6种皮瓣修复拇指腹缺损（锁骨下带蒂皮瓣、手指掌侧推进皮瓣、示指背侧皮瓣、带血管神经蒂的大鱼际近端皮瓣及趾腹游离皮瓣）共142例患者,进行了远期随访.随访内容有术后拇指腹色泽、外形、质地、出汗情况、拇指的痛觉、触觉、两点分辨觉、综合质地感觉及运动功能等.结果142例均获得了完整资料.6种皮瓣中,其中锁骨下带蒂皮瓣与示指背侧皮瓣修复的拇指腹,从皮肤色泽、外形、质地、出汗情况等均比其它4种皮瓣差,综合质地感觉优良率也明显低于其它4种皮瓣.结论手指掌侧推进皮瓣、指侧方血管蒂岛状皮瓣、带血管神经蒂的大鱼际近端皮瓣及趾腹游离皮瓣修复拇指腹缺损远期临床效果良好,但指侧方血管蒂岛状皮瓣对手部创伤较大,影响患手美观及供区手指的感觉.     

拇指皮肤缺损的早期显微外科修复

目的 报道应用不同类型的皮瓣修复拇指皮肤软组织缺损的临床疗效。方法 对43例拇指皮肤缺损患者，急诊应用7种方法治疗。其中拇指掌侧推进皮瓣8例，示指近节背侧岛状皮瓣15例，第一掌背逆行筋膜皮瓣4例，中、环指邻侧双岛状皮瓣3例，桡动脉鼻烟窝皮支逆行岛状皮瓣5例，带骨间后动脉的前臂逆行岛状皮瓣4例，mu趾甲皮瓣游离移植4例。结果 本组43例中，坏死1例，改用其它皮瓣修复；部分坏死2例，经换药痊愈。其余40例拇指外形较好，指腹感觉存在，活动正常或稍差于健侧，拇指能与2～5指对指。结论 不同程度的拇指皮肤缺损选用合适的方法修复，疗效可靠。     

应用改良的示指近节背侧皮瓣修复轻中度虎口挛缩

目的 介绍改良的示指近节背侧皮瓣在轻中度虎口挛缩治疗中的应用体会.方法 将原来的示指背侧岛状瓣或舌状瓣改成连同虎口一起的示指背侧局部转移皮瓣重建虎口,使皮瓣游离和虎口开大整体进行,简化了手术方法.结果 临床应用111例皮瓣全部成活,术后经3～18个月(平均8.5个月)的随访,局部外形美观,拇指功能恢复良好.虎口开大的优良率为94.6%.结论 改良的示指近节背侧皮瓣转位重建虎口是修复虎口挛缩的有效方法.     

应用改良的示指近节背侧皮瓣修复轻中度虎口挛缩

目的 介绍改良的示指近节背侧皮瓣在轻中度虎口挛缩治疗中的应用体会.方法 将原来的示指背侧岛状瓣或舌状瓣改成连同虎口一起的示指背侧局部转移皮瓣重建虎口,使皮瓣游离和虎口开大整体进行,简化了手术方法.结果 临床应用111例皮瓣全部成活,术后经3～18个月(平均8.5个月)的随访,局部外形美观,拇指功能恢复良好.虎口开大的优良率为94.6%.结论 改良的示指近节背侧皮瓣转位重建虎口是修复虎口挛缩的有效方法.     

拇指指腹缺损的显微外科修复

目的 探讨含感觉神经的微型皮瓣修复拇指指腹缺损的临床疗效.方法 2000年2月-2010年3月,采用食指背岛状皮瓣、中指侧方岛状皮瓣、以桡侧指动脉为蒂逆行岛状皮瓣、桡动脉掌浅支为蒂的逆行皮瓣、拇指尺背侧动脉逆行皮瓣、拇指背皮神经营养血管皮瓣、第2趾趾腹皮瓣、？？趾甲皮瓣、大鱼际部浅静脉动脉化逆行皮瓣共9种皮瓣修复重建拇指指腹缺损134例.结果 3例皮瓣坏死,131例成活,6个月～1.5年随访108例,皮瓣外形血供充分,质地柔软,感觉测定S2～S4＋,两点辫别觉6～11mm.结论 采用含感觉神经的微型皮瓣修复拇指指腹缺损,对供区影响小、效果佳、为理想的术式选择.     

应用改良的示指近节背侧皮瓣修复轻中度虎口挛缩

目的 介绍改良的示指近节背侧皮瓣在轻中度虎口挛缩治疗中的应用体会.方法 将原来的示指背侧岛状瓣或舌状瓣改成连同虎口一起的示指背侧局部转移皮瓣重建虎口,使皮瓣游离和虎口开大整体进行,简化了手术方法.结果 临床应用111例皮瓣全部成活,术后经3～18个月(平均8.5个月)的随访,局部外形美观,拇指功能恢复良好.虎口开大的优良率为94.6%.结论 改良的示指近节背侧皮瓣转位重建虎口是修复虎口挛缩的有效方法.     

The innervated first dorsal metacarpal artery island flap for reconstruction of post-traumatic thumb defect

Background

Various surgical techniques contribute to repair distal defects of the fingers, especially the thumb as traumatic loss diminishes or eliminates the thumb prehensile abilities and may affect overall hand function.

Methods

Ten innervated first dorsal metacarpal artery (FDMCA) island flaps were performed and evaluated postoperatively. The function of the thumb and the cosmetic appearance were documented for all patients.

Results

The flap survived with good cosmetic results in all cases. Grasping and pinching activity as well as cortical orientation was achieved for all flaps.

Conclusion

It appears that the FDMCA flap is one of the best solutions for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate, and stable skin cover. Level of Evidence: Level 4, therapeutic study.     

应用小皮瓣急诊修复拇指软组织缺损

目的 报道拇指软组织缺损的皮瓣修复方法及临床效果。方法 根据拇指软组织缺损的不同情况，采用6种小皮瓣进行修复，包括拇指桡侧指动脉逆行岛状皮瓣、拇指尺背动脉逆行皮瓣、第一掌背动脉逆行皮瓣，示指背侧岛状皮瓣、带神经血管蒂的V-Y推进皮瓣以及拇甲瓣等。临床应用132例，共137个皮瓣。结果 术后有5例皮瓣出现表皮小部分坏死，经换药处理后愈合，其余均成活。随访1～2年，拇指功能、外形满意。结论 对拇指软组织缺损选择恰当的小皮瓣急诊修复，可获得满意的临床效果。     

中环指岛状皮瓣、示指背侧岛状皮瓣转移修复拇指损伤

目的 评价中环指岛状皮瓣和（或）示指背侧岛状皮瓣转移修复拇指损伤的疗效。方法 １９８９年７月￣１９９８年１１月共８例拇指损伤应用中环指岛状皮瓣和（或）示指背侧岛状瓣修复。其中示指侧同状皮瓣转移修复拇指损伤２例,中指尺侧岛状皮瓣加示指背侧岛状岛状皮瓣转移修复拇指脱套伤１例,中环指双岛状皮瓣转移修复拇指撕脱离断伤１例。中指尺侧岛状皮拇指损伤４例。随访７个月－９年１１个月,平均５年１个月,主要观察皮     

The Foucher's "kite-flap" (12 cases)

The "kite-flap" is a cutaneous island flap containing a triple pedicle. It is harvested from the dorsum of the index and is intended to cover skin-loss on the thumb. The purpose of our study was to evaluate 12 "kite-flaps" performed over the course of 11 years. The skin defects were on the dorsum of the distal phalanx of the thumb in 3 cases, on the dorsum of both the distal and proximal phalanges in 4 cases and on the volar aspect of the thumb in 5 cases. The associated lesions consisted of combined bone and skin in one case treated by bone graft with external fixation, and one case of septic arthritis of the interphalangeal joint treated by arthrodesis. The results of our series are very good after an average of 2 years follow-up. We have however had 4 cases of cold intolerance, 2 cases of superficial sepsis and one case of shrinkage of the first commissure. It appears that the "kite-flap" is the best solution for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate and stable skin cover.