指背神经筋膜蒂逆行皮瓣蒂部不同处理修复指端缺损

目的探讨指背神经筋膜蒂逆行皮瓣蒂部不同处理修复指端缺损的临床疗效。方法对39例39指指端皮肤软组织缺损患者，设计指背神经筋膜蒂皮瓣逆行转移修复皮肤缺损，术中根据皮瓣血运情况，采用不同的蒂部处理方法转移皮瓣。蒂部创面直接缝合8例。蒂部带皮蒂10例，蒂部创面全厚皮片植皮21例．其中包括蒂部创面直接缝合及带皮蒂皮瓣发生血运障碍后，采用蒂部皮片植皮分别为4例和5例。结果39例皮瓣均成活。4例皮瓣其中蒂部创面直接闭合2例，蒂部单纯带皮蒂2例，术后发生静脉危象，明显肿胀并出现水疱，经抽吸水疱减张及小切口放血后皮瓣转为红润。术后随访5～8个月，皮瓣外形、手指功能均较满意。结论根据术中皮瓣血运情况．采用不同蒂部处理方式的指背神经筋膜蒂逆行皮瓣修复指端缺损．能明显降低皮瓣肿胀及血管危象的发生。

Reverse dorsal digital nerve fascial pedicled flap based on different treatment of pedicle for repairing fingertip defect

Objective To explore the clinical effect of reverse dorsal digital nerve fascial pedicled flap based on different treatment of pedicle for repairing fingertip defect. Methods The reverse dorsal digital nerve fascial pedicled flap were applied to repair 39 fingertip defects of 39 cases. By observing intraoperative blood supply of the flaps, the pedicle wounds were sutured directly （n=8）, with petey （n=10）, and full- thickness skin grafting （n=21）. Results All flaps survived. Venous crisis occurred in 4 flaps, which included pedicle wounds sutured directly （n=2） and with petey （n=2）. Postoperative follow-up period ranged from 5 to 8 months, the appearance and function of the fingers were acceptable. Conclusion According to blood supply of the flaps in operation, pedicle wounds should be treated with different ways, when reverse dorsal digital nerve fascial pedicled flaps repairs fingertip defects, which can significantly reduce the incidence of flap swelling and vascular crisis.