改良指背筋膜蒂皮瓣修复指腹软组织缺损

目的探讨改良指背筋膜蒂皮瓣修复指腹软组织缺损的临床效果。方法2018年6月至2019年3月,皖南医学院第一附属医院手足外科收治14例指腹缺损患者,男12例,女2例,年龄27~63岁,平均49岁。指腹缺损创面面积1.6 cm×1.4 cm~2.5 cm×1.6 cm,以患指背侧筋膜为蒂部设计皮瓣,旋转点不超过中节指骨的中点水平。倒L形切断远侧指间关节水平筋膜组织后翻转筋膜蒂及皮瓣,修复指腹缺损。近节供区以前臂全厚皮片移植修复。记录皮瓣术后存活情况,随访观察皮瓣外观、两点辨距觉,根据关节总活动度法对手功能进行评价。结果14例皮瓣全部成活,皮瓣大小1.8 cm×1.6 cm~2.7 cm×1.8 cm,其中1例皮瓣远端出现水泡,抽液换药后自行愈合。14例均获得5~12个月随访,平均8.9个月。皮瓣外观质地与周围组织相近,外观满意,末次随访评定手功能:优9例,良5例。皮瓣两点辨距觉8~11 mm,平均9.9 mm。结论改良指背筋膜蒂皮瓣切取简单、重建效果满意,可得到良好的临床效果。

Repair of finger-pulp defects with modified dorsal digital fasciocutaneous flap

Objective To evaluate the clinical outcome of the reconstruction of finger-pulp defects,using modified dorsal digital fasciocutaneous flap.Methods Between June 2018 and March 2019,14 patients with finger-pulp defects were admitted to the Department of Hand and Foot Surgery.There were 14 males and 2 females,aged from 27 to 63 years,with the mean age of 49 years.The defect areas of finger pulp were 1.6 cm×1.4 cm-2.5 cm×1.6 cm.All of the finger-pulp defects were treated by the modified dorsal digital fasciocutaneous flap and the inverted L-shaped incision was made at the distal part of the pedicle.The defects at donor sites were reconstructed with full-thickness skin grafts harvested from the forearm.Viability of the flap was recorded postoperatively.At the last follow-up,aesthetics,sensibility of the flap and hand performance were assessed.Results All of the 14 flaps survived successfully,the areas were 1.8 cm×1.6 cm-2.7 cm×1.8 cm.Partial distal blister occurred on the flap in only one case,which was solved by aspiration without surgical intervention.All cases acquired follow-up visits for 5 to 12 months with a mean time of 8.9 months.The texture of flaps was similar to surrounding skin and the shape of reconstructed finger pulp was satisfactory.According to the assessment of total active movement,the results were excellent in 9 fingers,good in 5 fingers.The 2-point discrimination of flap was 8 to 11 mm(mean,9.9 mm).Conclusions It is an effective and simple method for the reconstruction of finger-pulp defects using modified dorsal digital fasciocutaneous flap.The clinical effectiveness is definite.