指动脉逆行岛状皮瓣结合甲床扩大术修复指端缺损

目的 介绍指动脉逆行岛状皮瓣结合甲床扩大术治疗外伤性手指末节软组织缺损伴指甲缺损.方法 采用此方法治疗手指末节软组织伴指甲缺损35例38指.结果 所有皮瓣均成活,术后随访3～6个月,伤指的指端及指甲外形满意.结论 指动脉逆行岛状皮瓣结合甲床扩大术是治疗外伤性手指末节软组织伴指甲缺损的有效方法.     

显微外科花絮

指动脉岛状皮瓣的临床应用；足背逆行筋膜瓣移植修复罡毋趾软组织缺损；重建感觉的手指背侧逆行岛状皮瓣修复指腹指端缺损.[编者按]     

指蹼动脉m形岛状皮瓣修复手指末节脱套伤

目的 探讨指蹼动脉m形岛状皮瓣修复手指末节脱套伤的方法和临床效果. 方法 对末节脱套伤28例28指,采用逆行指蹼动脉m形岛状皮瓣修复,其中示指10指,中指13指,环指4指,小指1指,缺损平面均在远侧指间关节以远,缺损长度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指皮瓣全部成活,经6～29个月随访,皮瓣质地柔软,外观饱满,皮瓣的两点辨别觉达6～9mm,平均7.6 mm,手功能按TAM法评定,优良率达92.3％. 结论 指蹼动脉逆行m形岛状皮瓣修复手指末节脱套伤,手术简便、安全,疗程短,是一种较为实用的方法.     

超半环形指动脉逆行岛状皮瓣修复手指末节套脱伤

手指末节仅残留指骨、肌腱的套脱伤在以往的治疗中，不是采用残端缝合处理，就是采用腹部带蒂皮瓣，以保留手指的长度，但由于皮瓣无感觉，术后效果往往不太理想。而指动脉逆行岛状皮瓣由于皮瓣切取面积不够，无法修复此类损伤。2003年11月-2005年11月，我们采用超半环形指动脉逆行岛状皮瓣修复手指末节套脱伤18例21指，取得了良好的效果。     

掌背动脉逆行岛状皮瓣与邻指皮瓣瓦合修复末节缺失的手指中近节脱套伤

目的 分析掌背动脉逆行岛状皮瓣与邻指皮瓣瓦合修复末节缺失的手指中近节脱套伤的临床疗效。方法 回顾性分析自2014-08—2018-05采用掌背动脉逆行岛状皮瓣联合邻指皮瓣瓦合修复12例末节缺失的手指中近节脱套伤,术中采用手背掌背动脉逆行岛状皮瓣修复伤指背侧创面,带指固有神经背侧支及指背神经的邻指皮瓣覆盖伤指掌侧创面。结果 12例均顺利完成手术,随访时间12～26个月,平均18个月。移植的24块皮瓣均顺利成活,其中1例掌背动脉皮瓣出现张力性水泡,及时拆除蒂部部分缝线,皮瓣成活,创面逐渐自行愈合。供区植皮均一期成活。末次随访时伤指外观良好,皮瓣不臃肿,耐磨,质地与周围正常组织相近。掌侧邻指皮瓣静态两点辨别觉5～10 mm,平均7.2 mm;掌背动脉皮瓣为8～12 mm,平均9.5 mm;按照中华医学会手外科学会上肢部分功能评定试用标准评价临床疗效：优6例,良5例,可1例。结论 掌背动脉逆行岛状皮瓣与邻指皮瓣瓦合修复末节缺失的手指中近节脱套伤操作简便,皮瓣成活率高,伤指外形较美观,供区副损伤小,适合在基层医院中推广应用。     

超半环形指动脉逆行岛状皮瓣修复手指末节离断型脱套伤

手指末节离断型脱套伤无法再植时,治疗方法不多,多以带蒂皮瓣修复为主,恢复结果往往因皮瓣感觉、质地和耐磨性差,修复效果差.2005年11月至2007年5月,我们利用超半环形指动脉逆行岛状皮瓣修复手指末节离断型脱套伤8例,收到了良好的效果.     

甲床断层移植联合指腹皮瓣修复儿童AllenⅡ型指端背侧斜行缺损

目的观察甲床断层移植联合V-Y推进皮瓣或顺行指动脉岛状瓣修复儿童AllenⅡ型指端背侧斜行缺损的临床效果。方法自2017年1月至2021年6月, 我们采用甲床断层移植联合指腹皮瓣修复儿童Allen Ⅱ型指端背侧斜行缺损患者11例11指, 指背甲床缺损行指/趾断层甲床移植修复, 掌侧及指端创面行V-Y推进皮瓣修复7例, 顺行指动脉岛状瓣修复4例。术后随访甲床愈合情况、患指外观及功能情况。结果术后所有皮瓣、移植甲床均完全存活, 术后2周拆包换药见甲床、皮瓣愈合良好, 无感染、甲床坏死、骨外露等并发症。术后随访时间为6～35个月, 平均21.5个月, 患指指端饱满有弹性, 指甲平整, 无嵴状、裂甲、钩甲等畸形, 甲板被覆恢复时间短。根据吕桂欣等的方法对甲床修复效果进行疗效评定:优8指, 良3指。根据中华医学会手外科学会上肢部分功能评定试用标准评定患手功能:优11指。结论甲床断层移植联合指腹皮瓣修复儿童Allen Ⅱ型指端背侧斜行缺损疗效确切, 手术操作较简单, 值得临床推广。     

部分踇甲瓣和第二趾腹皮瓣联合修复指脱套伤

目的探讨2～4指全指脱套伤的修复方法,寻找最佳术式. 方法切取携带足背皮瓣的部分踇趾甲皮瓣修复手指背侧和部分掌侧,第二趾侧腹皮瓣修复指掌侧软组织缺损,形成一个血管蒂的部分踇趾甲皮瓣及第二趾侧腹皮瓣修复全手指脱套伤. 结果临床应用6例9指全部成活,受区伤口Ⅰ期愈合8指,其中有1例为双侧踇甲瓣及第二趾侧腹皮瓣修复示、中指,因中指近指间关节(DIP)有脱位,末节指骨坏死,死骨摘除,3个月后伤口愈合,皮瓣成活,原修复指甲及甲床也坏死.供区除1例踇甲瓣供区植皮部分坏死外,余Ⅰ期愈合,术后随访6～14个月,掌指关节活动度60°～70°,近指间关节活动度40°～50°,指腹饱满,两点辨别觉8～12 mm,外形逼真,指甲生长良好,有1指指甲萎缩,1指指甲已缺损,供区行走良好,无疼痛及足部肿胀,植皮处肤色深,关节活动无影响. 结论部分踇甲瓣联合第二趾腹皮瓣是一种修复全手指脱套伤的理想方法.     

吻合指背侧皮神经的指动脉逆行岛状瓣修复末节指腹皮肤缺损

现代手工业比较发达,因各种机器致伤而导致的手指末节指腹皮肤缺损较多,且多数伴有肌腱及骨质外露,以往经常选用邻指皮瓣、指背筋膜皮瓣、指动脉逆行岛状皮瓣修复末节指腹缺损,虽然解决了皮肤覆盖问题,但感觉迟钝或无感觉,经常发生冻伤及烫伤,影响手指的功能。我院近2年来采用吻合指背侧皮神经的指动脉逆行岛状皮瓣修复末节指腹皮肤缺损26例,重建了皮瓣的感觉,使移植皮瓣的外形及功能接近正常,大大提高了伤指的使用率,现报道如下。     

静脉动脉化指背筋膜蒂逆行岛状皮瓣修复手指组织缺损

目的 探讨静脉动脉化指背筋膜蒂逆行岛状皮瓣修复手指中、末节软组织缺损的临床效果.方法 对29例30指中、末节软组织缺损患者通过指固有动脉断端与皮瓣的静脉吻合,指固有神经断端与指背筋膜蒂逆行岛状皮瓣的皮神经吻合,形成带感觉的静脉动脉化逆行岛状皮瓣修复.结果 29例30指皮瓣全部成活.全部伤口Ⅰ期愈合,皮瓣供区植皮成活.术后随访6～16个月,平均9个月,手指功能与外观均满意,皮瓣质地良好,指端饱满,无触压痛,感觉恢复良好,静止两点分辨觉5～10 mm.结论 静脉动脉化指背筋膜蒂逆行岛状皮瓣修复手指中、末节软组织缺损是一种较为理想的方法.     

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.     

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。     

拇趾甲皮瓣及尺动脉腕上皮支下行支皮瓣瓦合并髂骨植骨再造拇指末节缺损

目的探讨拇趾甲皮瓣及尺动脉腕上皮支下行支皮瓣瓦合并髂骨植骨再造拇指末节缺损的临床疗效。方法对7例拇指末节缺损患者分别采用吻合血管拇趾甲皮瓣修复拇指背侧皮肤及指甲缺损、尺动脉腕上皮支下行支皮瓣修复拇指末节掌侧皮肤缺损、末节指骨缺损取髂骨移植。拇趾甲皮瓣供区采用游离植皮5例,同侧第2趾胫侧方皮瓣顺行覆盖2例;尺动脉腕上皮支下行支皮瓣供区均直接缝合。结果 7例拇趾甲皮瓣及尺动脉腕上皮支下行支皮瓣均顺利成活,伤口一期愈合。其中1例拇趾甲皮瓣供区植皮出现部分坏死,经换药后愈合。末节植骨愈合时间为8~11周,平均10周。去除内固定物后行规律功能锻炼。所有患者获随访6~15个月,平均8个月,移植组织成活及拇指指甲生长良好,指腹皮瓣两点辨别觉为8~10 mm(平均9 mm);足部供区皮瓣及植皮无破溃,足部功能未受影响。结论采用拇趾甲皮瓣及尺动脉腕上皮支下行支皮瓣瓦合并髂骨植骨再造拇指末节能较好地恢复拇指外形及功能,是一种较好的临床治疗方法。     

Reconstruction of distal phalanx defect with microsurgical fascia latae flaps combined with rib and skin graft]

OBJECTIVE: To evaluate the clinical application of microsurgical fascia latae flaps combined with rib and skin graft for reconstruction of the distal phalanx defect. METHODS: The phalanx wounds were sutured together like syndactyly. The autologeous rib was revised to repair the bone defect of distal phalanx. The fascia latae flap was used to cover the bone exposure with microvascular anastomoses and resurfaced by a meshed split-thickness skin graft. RESULTS: 5 cases were treated successfully. The fascia latae flaps were all survived with only skin graft necrosis at the distal end in one case. It was healed spontaneously. CONCLUSIONS: The fascia latae flap is nourished by the desending branch of the lateral circumflex femoral artery. The flaps has a good blood supply and can be easily obtained with a long vascular pedicle. The flap is ideal for the reconstruction of distal phalanx defect when combined with autologeous rib implant and skin graft.     

改良第二掌背动脉皮瓣修复示中指中末节套脱伤

目的 探讨应用第二掌背动脉(second dorsal metacarpal artery,SDMA)逆行岛状皮瓣修复示、中指中末节皮肤套状撕脱伤的方法及疗效.方法 2004年5月至2010年1月,收治17例示指或中指中末节皮肤套状撕脱伤患者.采用SDMA岛状皮瓣进行修复,并缝合指背神经.皮瓣切取面积为2.5 cm×5.6 cm～5.0cm×6.5 cm,供区创面行游离植皮.结果 术后2例皮瓣远端出现张力性水泡,表皮结痂,经换药后愈合;其余皮瓣顺利存活.皮瓣及供区植皮切口均Ⅰ期愈合.术后17例获得4～27个月的随访,平均15.3个月.皮瓣质地柔软,外观饱满无臃肿.两点分辨觉为7～11 mm,平均8.6 mm.手功能按手指总主动活动度(total active movement,TAM)法评定:优8指,良7指,可2指;优良率为88.2%.结论 缝合指背神经的改良SDMA逆行岛状皮瓣,皮瓣切取面积足够覆盖示、中指中末节套状撕脱伤皮肤缺损创面,皮瓣血运可靠,手术安全,是一种较好的手术方法.

Abstract：

Objective To investigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery (SDMA) for repairing index or long finger degloving defects.Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA.The dorsal digital nerve in the flap was coapted to the severed proper digital nerve.The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0 cm × 6.5 cm.The donor sites were closed by skin graft.Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change.All the other flaps survived uneventfully.Primary healing of the flaps and donor sites was achieved.All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months.The flaps were pliable, full but not bulky.Two-point discrimination was 7 to 11 mm (mean 8.6 mm).Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers.The satisfactory rate was 88.2%.Conclusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries.The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx.The surgery is safe due to the reliable flap circulation.     

第二趾套状切取加踇趾腓侧皮瓣组合移植治疗手指大部皮肤脱套伤

目的　探讨手指大部皮肤脱套伤的治疗方法及疗效。方法　对 12例 19指手指大部皮肤脱套伤患者 ,采用套状切取第二趾及趾腓侧皮瓣 ,修复伤指软组织的治疗方法。第二趾的皮肤及软组织套入包含浅筋膜、肌腱、指神经及骨架的伤指上 ,趾腓侧皮瓣嵌入第二趾软组织的腹侧以增大其周径。结果　 19指的皮瓣全部存活。术后随访半年 ,重建指的外形、感觉、运动功能恢复满意 ,血运稳定。X线片复查无骨质吸收。结论　第二趾套状切取加趾腓侧皮瓣组合重建术是治疗手指大部皮肤脱套伤的有效方法。     

半趾甲瓣移植手术供区创面的修复处理

目的 探讨半趾甲瓣移植术的供区创面修复方法.方法 自2004年2月至2010年9月,采用带蒂或游离皮瓣修复趾甲瓣足趾供区创面36例40指.趾供区面积较小者13趾采用第一跖背皮瓣、7趾用第二趾动脉皮瓣修复;面积大者采用游离皮瓣修复,其中足底内侧皮瓣3趾,腓动脉穿支皮瓣5趾,跗外侧动脉皮瓣2趾,腓肠动脉内侧支皮瓣3趾.第二趾半趾甲瓣再造手指7趾,其创面均采用(母)趾腓侧岛状皮瓣覆盖.结果 20例术后获得6个月至5年随访,其中2例甲缘外露在皮瓣外,18例(母)趾、第二足趾外观近似正常,皮瓣平整无破溃,皮瓣颜色质地好;游离皮瓣中有7例恢复保护性感觉;修复足趾屈伸活动正常,行走无不适感.结论 用皮瓣移植覆盖(母)趾及第二趾半趾甲瓣创面是理想修复方法,游离皮瓣移植好于带蒂移植.

Abstract：

Objective To explore the wound healing of semi-toe nail flap donor site after transplantation. Methods To repair small wounds,on 13 toes the first metatarsal dorsal flaps were applied,and on 7 toes the second toe digital flaps were applied.While,to repair large wounds,free flaps were applied,including foot inside flaps on 3 toes,peroneal artery perforator flaps on 5 toes,tarsal lateral artery flaps on 2 toes,and phil bowel artery inside branch flaps on 3 toes.Wounds remaining on semi-toe nail flaps of 7 toes were all covered with fibular island flaps of the first toes. Results Twenty cases were followed up,and the rang between 6 months to 5 years.The nail margin was exposed out of the lateral flaps in 2 cases.The first toes and the second toes appeared nearly normal in the other 18 cases.The flaps appeared smooth,flexible appearance with nice color and no ulceration.Seven cases applied with free flaps recovered protective sensibility with no complaint. Conclusion To cover wounds on semi-toe nail flaps of the first toes and the second toes with flaps is an ideal treatment method.The method of free flap transplantation is superior to vascular pedicle flap graft.     

Radical resection of a venous malformation in middle finger and immediate reconstruction using medial plantar artery perforator flap: a case report

Reconstruction of complex defects resulting from radical resection of venous malformation occurring in other digits except the thumb is challenging because a thin and durable flap is required to achieve optimal reconstruction without functional impairment. Here, we describe an alternative reconstruction technique in a young patient. A 15-year-old female patient with venous malformation of the left 3rd finger was treated by radical excision of the tumor including involved skin, distal phalanx, and nail bed followed by reconstruction with free medial plantar artery perforator flap and split thickness nail bed graft from the great toe. Twenty-nine months after surgery, the reconstructed finger showed a acceptable aesthetic result without tumor recurrence and excellent restoration of motor function. This method can be considered as an useful alternative option for management of the digital venous malformation in other digits except the thumb. Indications and technical aspects of this method are discussed in this report.     

急诊修复拇指指腹缺损三种方法的研究

目的 报道采用不同方法急诊修复拇指指腹缺损的疗效。方法 采用示指背侧岛状皮瓣，拇指桡侧指动脉逆行岛状皮瓣转位有趾腹皮瓣游离移植三种方法，为21例线指指腹缺损进行急诊修复。结果 20例以瓣成活，1例失败。术后随访半年－2年，平均10个月。所有皮瓣血运，弹性，质地均良好。指腹二点分辨觉：示指背侧岛状皮瓣平均为92.mm，拇指桡侧动脉逆行岛状皮瓣平均为8mm，趾腹皮瓣平均为5.6mm。结论 急诊修复拇指指腹缺损首选趾腹皮瓣，其次为拇指桡侧指动脉逆行岛状皮瓣或示指背侧岛状皮瓣。