不同手部皮瓣修复拇指末节创面疗效分析

目的总结研究拇指末节皮肤软组织缺损的不同皮瓣修复及感觉重建方法。方法应用不同皮瓣修复拇指末节皮肤软组织缺损患者39例。其中拇指桡背侧皮瓣14例,尺背侧皮瓣8例,示指背侧动脉皮瓣6例,推进皮瓣5例,V-Y皮瓣6例,男28例,女11例,年龄15～60岁,平均37.8岁,术前均行X线检查以明确骨折情况。缺损部位：拇指末节掌侧15例;拇指末节背侧6例,拇指末节桡侧5例,拇指末节尺侧6例,指端7例。皮瓣面积：1.5cm×1cm～4cm×3cm。结果其中2例皮瓣早期出现皮瓣边缘血运障碍,经换药痊愈,其它皮瓣均一期完全成活,术后39例均获随访,时间6个月～3年,平均20个月。皮瓣外形好,质地耐磨,指间关节伸屈活动70°～90°,对掌功能正常。吻合神经皮瓣两点辨别觉：5～10mm。结论 5种皮瓣修复拇指末节皮肤软组织缺损简单易行,安全可靠,功能良好,显微镜下将皮瓣内神经与受区内神经精细吻合,能够获得良好的感觉功能。不同部位的缺损宜采用不同的皮瓣修复。

The analysis of different flaps in the repair of soft tissue defect of distal phalange of thumb.

Objective To discuss the Methods of flap repair and sensation reconstruction in the treatment of skin and soft tissue defect in the thumb. Methods Different flaps were applied in 39 cases suffered skin and soft tissue defects in the thumbs, including 14 thumb radial and dorsal flaps, 8 thumb ulnar and dorsal flaps, 6 index finger dorsal artery flaps, 5 advanced skin flaps, 6 V-Y flaps. 28 male patients,//female patients, from fifteen years old to sixty years old, averaged 37.8 years old. X-ray was carried out to identify the fracture. Defect sites： volar aspect of distal phalange of the thumb in 15 cases, dorsal in 6, radial in 5, ulnar in 6 and finger tip in 7. The flap areas were 1.5 cm ~ 1 cm-4 cm ~ 3 cm. Results All the flaps survived completely except two cases, which suffered vascular dysfunction in early time and healed after changing dressings. All the 39 cases were followed up, from 6 months to 3 years, with an average of 20 months. The flaps had good shapes and were wear resisting. The range of motion of the finger joints was from 70 degrees to 90 degrees. The opposition function was normal. Two point discrimination in the flaps which anastomosing the nerves was 5~10 rmn. Conclusion These five kinds flaps are simple, easy and safe to carry out. Good sensation function can be achieved by the anastomosis of the nerves in the flap and in the recipient area under microscope. The defects in different sites should be repaired with different flaps.