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.

Repair of the thumb pulp loss with six flaps: a long period follow-up

Objective To investigate the results of six flaps for repair of the thumb pulp defects. Methods The 142 patients who had accepted thumb reconstruction with 6 flaps before Dec, 2001 were made a long period followup. The subclavian pedicle flap, the volar digital advancement flap, the lateral digital neurovaseular island flap, the dorsal digital flap, the approximate radial thenar flap and the big toe skin flap had been undergone for 142 patients,and summarized the results of 142 patients whose data were completely acquired, according to the shapes ,sweating, sensory and motor functions etc. Results The shapes , sweating and sensory of the thumb pulp with the subclavian pedicle flap and the dorsal digital flap repair were poor compared with the others flaps. Conclusion The volar digital advancement flap,the lateral digital neurovaseular island flap, the approximate radial thenar flap and the big toe skin flap were good methods for repair the thumb pulp defects, but the lateral digital neurovaseular island flap was more trauma procedure than the others, and influenced the sensory of donor site.