伤指背筋膜岛状皮瓣修复手指软组织缺损

目的 介绍以伤指指背筋膜为蒂，带指固有神经背侧支的岛状皮瓣顺行或逆行转移修复指腹或指背软组织缺损的方法。方法 在手指近、中节背侧沿指固有神经背侧支走行方向设计并切取筋膜蒂皮瓣，切取皮瓣时蒂部带一矩形皮瓣，以减轻转位后皮瓣蒂部的张力。皮瓣顺行转移不需缝合神经，逆行转移时与受区神经缝合。皮瓣切取范围不超过手指侧中线，切取面在腱周浅层，皮瓣转移轴线沿指固有神经背侧支走向。结果 本组17例22指皮瓣全部成活。结论 采用伤指指背筋膜蒂岛状皮瓣转移修复指腹或指背皮肤缺损是一种简单安全，行之有效的手术方法。     

缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损

目的 探讨缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损的疗效.方法 2008年12月至2009年11月,对24例26指指远端皮肤缺损患者,以指固有动脉背侧支形成的血管链为血供,于近节指体侧方设计皮瓣,皮瓣轴线为指体侧方中线,皮瓣蒂宽0.8～1.0cm,皮瓣转折点为中节指体中远端,逆行转移修复指远端皮肤缺损,皮瓣携带指固有神经背侧支或指背神经与创面指神经断端进行缝合修复,重建手指感觉.结果 术后26指皮瓣均存活.随访时间为6～8个月,皮瓣外形理想,质地良好,感觉恢复优良,两点分辨觉为4～8 mm,患指指间关节平均活动度恢复优良.结论 采用缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损,操作简单,血供可靠,不牺牲指固有动脉、神经,供区损伤小,术后并发症少,并能重建感觉,是一种理想的手术修复方法.     

缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损

目的 探讨缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损的疗效.方法 2008年12月至2009年11月,对24例26指指远端皮肤缺损患者,以指固有动脉背侧支形成的血管链为血供,于近节指体侧方设计皮瓣,皮瓣轴线为指体侧方中线,皮瓣蒂宽0.8～1.0cm,皮瓣转折点为中节指体中远端,逆行转移修复指远端皮肤缺损,皮瓣携带指固有神经背侧支或指背神经与创面指神经断端进行缝合修复,重建手指感觉.结果 术后26指皮瓣均存活.随访时间为6～8个月,皮瓣外形理想,质地良好,感觉恢复优良,两点分辨觉为4～8 mm,患指指间关节平均活动度恢复优良.结论 采用缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损,操作简单,血供可靠,不牺牲指固有动脉、神经,供区损伤小,术后并发症少,并能重建感觉,是一种理想的手术修复方法.     

Double reverse-flow island flaps for two adjacent finger tissue defect

INTRODUCTION: Soft-tissue reconstruction of fingertip injuries remains a challenge for hand surgery. Tissue loss of multiple digits is a serious problem for hand surgeons. Surgical possibilities include regional, distant and local flaps. In this study, five patients presented with tissue loss of two adjacent fingers and were treated by double reverse-flow island flaps. MATERIALS AND METHODS: The surgical technique is an application of the reverse-flow homodigital island flap for two adjacent finger tissue defects. Instead of one flap, double island flaps are applied to two adjacent finger tissue defects. The flaps are raised from the lateral or medial palmar surface of the proximal phalanx level. Anastomoses between the radial and ulnar digital arteries at the distal interphalangeal joint level are preserved. RESULTS: Three of the patients had tissue defects at the fingertip. In these cases, digital nerve anastomosis with the counter lateral digital nerve made the flaps sensitive. In two patients, the tissue defect was on the dorsum of the middle phalanx level. In these cases, the flaps were non-sensitive. Neither infection nor flap failure was seen in the patients. Sensitive function was satisfactory in fingertip applications. CONCLUSION: The reverse-flow homodigital island flap is a commonly used surgical technique for tissue defects in the fingers. The double reverse-flow island flaps involve the application of this technique for two adjacent fingers. The important point in the surgical technique is that the vascular supply of the two flaps should originate from the same common palmar digital artery. This technique offers a possibility to repair the defects of two adjacent fingers.     

缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损

目的 探讨缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损的疗效.方法 2008年12月至2009年11月,对24例26指指远端皮肤缺损患者,以指固有动脉背侧支形成的血管链为血供,于近节指体侧方设计皮瓣,皮瓣轴线为指体侧方中线,皮瓣蒂宽0.8～1.0cm,皮瓣转折点为中节指体中远端,逆行转移修复指远端皮肤缺损,皮瓣携带指固有神经背侧支或指背神经与创面指神经断端进行缝合修复,重建手指感觉.结果 术后26指皮瓣均存活.随访时间为6～8个月,皮瓣外形理想,质地良好,感觉恢复优良,两点分辨觉为4～8 mm,患指指间关节平均活动度恢复优良.结论 采用缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损,操作简单,血供可靠,不牺牲指固有动脉、神经,供区损伤小,术后并发症少,并能重建感觉,是一种理想的手术修复方法.

Abstract：

Objective To explore the effect of using proper digital artery lateral cutaneous branch-chain flap with dorsal digital nerves or dorsal branch of proper digital nerye for repairing of fingertip defect.Methods From December 2008 to November 2009, 24 cases (26 digits) of fingertip defect were treated with proper digital artery lateral cutaneous branch-chain flap.The flap was designed on the lateral side of the proximal phalanx of the injured finger with its long axis running on the lateral midline of the finger.The vascular pedicle was 0.8 to 1.0 cm wide.The pivot point was at the distal 1/3 of the middle phalanx upon which the flap was reversed to repair the defect of the fingertip.The dorsal digital nerve or dorsal branch of proper digital nerve was included in the flap and coapted with the nerve in the wound to reconstruct sensation of the injured finger.Results All 26 flaps survived.Postoperative follow-up period was 6 to 8 months.All these flaps recovered with satisfying and quality, excellent sensation with 4 to 8 mm two-point discrimination.ROM of the interphalangeal joint of the injured finger was good.Conclusion Proper digital artery lateral cutaneous branchchain flap transfer with nerve coaptation is an ideal method for repairing fingertip defect.The surgery is simple.Reliable blood supply can be achieved without sacrificing the proper digital artery.Coaptation of the nerve restores sensation at the fingertip.There is minor donor site damage and very few complications.     

The heterodigital reversed flow neurovascular island flap for fingertip injuries.

We report the results of pulp reconstruction with a new heterodigital reverse flow island flap. A dorsolateral flap from the middle phalanx, based on the digital artery is raised from the adjacent uninjured finger. The common digital artery, between the injured finger and the donor finger, is ligated and transected just before its bifurcation. The two converging branches of the digital arteries can be entirely mobilized as a continuous vascular pedicle for the flap. Thus the vascularization is now supplied by reverse flow through the proximal transverse digital palmar arch of the injured finger. To provide sensation the dorsal branch of the proper digital nerve from the donor finger can be included in the flap. Six reverse heterodigital island flaps were used in patients. In five patients the flap was used for pulp reconstruction and in one case for covering a dorsal digital defect. In one case mild venous congestion occurred. Good skin coverage with supple and well-vascularized skin was obtained in each patient. The static two-point discrimination over the flap was between 6 and 15 mm. This new procedure is indicated for extensive pulp defects in fingers in which reconstruction cannot be done using other flaps and as an alternative to microsurgical reconstruction.     

Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

Background:

Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip.

Materials and Methods:

Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site.

Results:

Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.

Conclusion:

Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.     

缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣术后供区皮肤缺损

目的：探讨采用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣切取后指神经裸露及软组织缺损的方法及疗效。方法应用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣移植后供区软组织缺损20例21指,软组织缺损面积：1.5 cm×2.0 cm～2.0 cm×3.0 cm。随访检测患指皮瓣外观、关节活动度及感觉等指标。结果术后20例皮瓣全部成活。术后经5个月随访,修复后患指指动脉皮瓣供区外形饱满,质地柔软,局部皮肤感觉及供区各关节活动范围令人满意。结论采用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣切取后供区指神经裸露及软组织缺损是有效而简单的方法,并可获得良好的外形及功能。     

Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery

The dorsal digital and metacarpal island flaps have been described for use in a variety of clinical situations. On the basis of the authors' previous angiographic studies, these two skin flaps were planned on the dorsum of the proximal phalanx or intermetacarpal space based on the vascular anastomoses between the proximal dorsal cutaneous branches of the palmar digital artery and the dorsal digital branches of the dorsal metacarpal artery at the level of the proximal phalanx. The authors present a series of 13 patients using these flaps. To reconstruct the injured finger pulp, the reverse dorsal digital flap was used in 5 patients, and the reverse dorsal metacarpal flap was used in 8 patients. Most of the 13 patients sustained a work-related injury. Associated injuries of bone, joint, or tendon occurred in most patients. In all patients, the skin defect was located distal to the proximal interphalangeal joint. The skin paddle was taken from the dorsal aspect of the middle and ring fingers or the first, second, third, and fourth metacarpal area. All flaps survived completely. Two patients who had the dorsal branch of the sensitive radial nerve anastomosed to the digital nerve recovered 6-mm two-point discrimination in the reverse dorsal digital flap. The results of this anatomic study and the authors' clinical experience confirm the reliability of the dorsal digital and metacarpal island flaps.     

Innervated reverse island flap based on the end dorsal branch of the digital artery: surgical technique

Fingertip or pulp loss of the fingers is observed frequently in unskilled workers. To reconstruct a sensate fingertip or pulp we designed the innervated reverse island flap based on the end dorsal branch of the digital artery, which was harvested from the dorsum of the middle phalanx. The sensation of the fingertip or pulp was re-established through coaptation of the proper branches of the digital dorsal nerves to the digital nerves. Three fingertip or pulp defects were reconstructed with this technique. All patients achieved satisfactory functional and cosmetic results. The mean follow-up time was 7.7 months. The average size of the flaps was 1.6 x 1.8 cm. The average static 2-point discrimination and moving 2-point discrimination of the flaps were 4.6 mm and 3.0 mm, respectively. The technique we applied seems to be an excellent option for 1-stage reconstruction of fingertip or pulp defects.     

跨区供血的手部微型岛状皮瓣的设计和应用

目的：探索修复手指中节和末节皮肤缺损的新方法。方法：16例新鲜肢体血管灌注氧化铅－明胶混合液,通过X线片显示手背及指背皮肤内的血管结构和血管之间吻合类型。在此基础上设计并应用了两种不同的跨区供血的手部微型岛状皮瓣,1999年以来共应用14例（以指动脉侧支为蒂的掌背逆行岛状皮瓣8例和以指动脉背侧支为蒂的邻指背侧逆行岛状皮瓣6例）。结果：对指背及掌背皮肤进行解剖,结果表明指动脉背侧皮支与掌背动脉的指背支相互吻合形成皮下血管吻合支,是上述两种皮瓣的解剖基础。临床应用14例,皮瓣全部成活,皮瓣色泽、厚度与质地与手部受区皮肤接近。结论：跨区供血的手部微型岛状皮瓣扩大了指背和掌逆行岛状皮瓣的旋转弧度,为修复手指中节和末节皮肤缺损提供了一种新方法。     

Reverse digital artery island flap in the elderly

The following case report illustrates the successful use of the reverse digital artery island flap in elderly patients. The reverse digital artery island flap is a recognised method of providing good quality soft tissue cover to the amputated fingertip. First described in 1986 by Kojima, Lai and Han have reported their experience of 52 and 120 of these flaps, respectively. The majority of patients in the literature are less than 50 years old, with ages ranging from 3 to 62 years. The flap is based upon reversed flow in the digital artery via a communicating branch from the contralateral artery at a point 5mm proximal to the distal interphalangeal joint crease. In the two cases reported below, we have shown that the indications for this type of homodigital flap reconstruction for fingertip amputations can be safely extended to elderly patients.     

Innervated dorsal adipofascial turnover flap for fingertip amputations

Traumatic or thermal injury to the fingertip may result in composite tissue loss. Exposed tendon, bone, or joint surface is best treated by flap coverage. The authors present their experience with a new technique that provides coverage for fingertip defects using the innervated dorsal adipofascial turnover flap, which consists of adipofascial tissue only and relies on the arterial anastomotic network of this tissue layer to sustain its vascularization. Eight digital amputations between the distal phalanx proximal to the nail matrix and midportion of the middle phalanx were resurfaced successfully with the innervated dorsal adipofascial turnover flap. The flaps survived completely; the mean follow-up was 9 months. This technique seems to be a relatively simple way of achieving early recovery. It does not require the use of distant flap immobilization of adjacent digits, nor does it require the use of homodigital flaps, which may jeopardize an already injured finger. The main advantages of the innervated dorsal adipofascial turnover flap are its ready availability from the local tissue, its sensation, and the absence of functional and aesthetic disturbance at the donor site.     

Free dorsal middle phalangeal finger flap

Three patients underwent finger reconstruction using free dorsal middle phalangeal finger flaps (DMF flaps). All flaps survived. The free DMF flap relies on blood flow from the dorsal branches of the digital artery and is harvested from the skin on the dorsum of the middle phalanx. The digital artery gives rise to four dorsal branches; two in the middle and two in the proximal phalangeal regions. The flap is based on the dorsal branch of the digital artery that passes near the center of the phalanx. The characteristic feature of the free DMF flap is that the dorsal cutaneous veins are used as drainage vessels. Unlike island flaps, blood congestion does not occur after free DMF flap surgery. Sensibility of the free flap may be obtained by inclusion of the dorsal branches of the digital nerves in the flap pedicle. Loss of the digital artery at the donor site can be circumvented with venous grafting. Surgery under brachial plexus block is an advantage of this flap. The free DMF flap is a useful technique for skin and soft-tissue defects.     

指背动脉蒂逆行岛状皮瓣修复指端皮肤缺损

介绍一种修复手指末端皮肤缺损的新型逆行岛状皮瓣。对12只新鲜尸体手标本分别经桡动脉灌注红色乳胶及制作动脉铸型标本对照观察，并对掌背动脉及指背动脉进行显微解剖，可见掌背动脉与掌侧动脉在近节指骨底有交通支相连，掌背动脉的终末支指背动脉，与指掌侧固有动脉的背侧分支在指背形成丰富的血管吻合网。指背动脉与指掌侧固有动脉的吻合支丰富，可以其为蒂，设计成逆行岛状皮瓣。2002年6月-2004年8月，临床应用该皮瓣修复手指末端皮肤缺损16例，皮瓣全部成活，平均随访11(2—26)个月，所有皮瓣质软、弹性好，供区无明显畸形，患者满意。该皮瓣设计合理、血供可靠、操作简便，适于手指末端软组织缺损的修复。     

指端缺损的急诊岛状皮瓣修复

目的介绍8种指岛状皮瓣对指端缺损创面的修复,并探讨其相关手术适应证。方法应用指神经血管束VY岛状推进皮瓣、拇指尺背侧动脉逆行皮瓣、指动脉背侧支逆行皮瓣、改良Moberg皮瓣、指动脉逆行皮瓣、Hueston皮瓣、指筋膜脂肪翻转瓣、指总神经血管束蒂双翼皮瓣等8种皮瓣修复79例82指指端缺损。结果手指外形和功能均取得了令人满意的结果。结论这些指岛状皮瓣适宜指端缺损的修复。     

改良邻指指动脉逆行岛状皮瓣的应用

目的 探讨改良邻指指动脉逆行岛状皮瓣修复手指中节以远掌侧皮肤软组织缺损的手术方法。方法 以指总动脉作为邻、患指指掌侧固有动脉逆行供血通道，在患指近侧指间关节近侧平面为旋转点，设计邻指指动脉岛状皮瓣逆行翻转，修复10例手指中节以远掌侧皮肤软组织缺损，同时将皮瓣上的感觉神经与患指远端指神经缝合。结果 10例皮瓣全部成活，术后随访6～15个月。手指外观饱满，皮瓣颜色与正常手指相似，皮瓣质软，两点分辨觉为4mm。供区手指功能无影响。结论 改良邻指指动脉逆行岛状皮瓣适用于修复手指中节以远掌侧皮肤软组织缺损创面的覆盖，术后疗效满意。     

指动脉逆行岛状皮瓣的临床应用

目的 通过对280例指动脉逆行岛状皮瓣修复手指缺损的临床分析，探讨本术式修复手指缺损的临床疗效。方法 1999年12月—2005年6月，对280例手部不同指别、不同部位的皮肤缺损患者，采用指动脉逆行岛状皮瓣进行修复，术后对其疗效进行随访分析。结果 术后280例皮瓣全部存活，其中5例皮瓣于术后48h内出现静脉回流障碍，经拆除部分缝线、换药后愈合。术后随访1～2年，其中27例皮瓣出现不同程度的并发症，如皮瓣臃肿、瘢痕挛缩、怕冷、冻疮、供区瘢痕触痛、麻木等。280例中，95例为指腹缺损而行皮瓣内神经与指背神经缝合，术后皮瓣感觉恢复满意，两点分辨觉为5～9him，外形较未缝合神经的皮瓣饱满。结论 指动脉逆行岛状瓣修复手指缺损不失为一种较好的方法，但要正确选择适应证，注意术后并发症的预防。     

指背侧岛状皮瓣在手指皮肤缺损中的临床应用

目的 探讨以手指背侧微血管网为血管蒂的手指近、中节背侧皮瓣逆行修复手指不同平面皮肤缺损的临床效果.方法 2007年1月-2011年12月,以近节及中节手指桡、尺背侧的手指背侧微血管网为血管蒂,逆行修复手指近指间关节掌侧,及其以远指体掌背侧及侧方皮肤缺损60例78指,皮瓣大小为1.2 cm×2.0 cm～2.5 cm×3.5 cm.结果 术后随访6～36个月,73指皮瓣成活,5指中节指背皮瓣远端部分坏死,经换药后创面愈合.术后皮瓣两点辨别觉8～10 mm,指间关节活动功能好.结论 该皮瓣具有操作简单、不损伤指固有动脉及指固有神经等优点.近节指背皮瓣面积大、血管蒂长、旋转弧大、成功率高.中节指背皮瓣血管蒂短,可用于修复末节甲根及甲中段平面背侧及指侧方皮肤缺损.     

指动脉终末背侧支逆行皮瓣

目的：介绍用指动脉终末背侧支逆行皮瓣修复指端软组织缺损及覆盖裸骨的疗效。方法：应用指动脉终末背侧支血管蒂的中节指背皮瓣逆行转移修复指端软组织缺损5例。结果：术后皮瓣全部存活，外形满意。结论：该术式是目前临床上以最纤细血管分支命名的血管蒂皮瓣之一，可避免损伤指固有血管，手术简便。