近节指背筋膜蒂逆行岛状皮瓣修复指端缺损的临床疗效

目的观察应用近节筋膜蒂逆行岛状皮瓣修复指端缺损的疗效。 方法回顾性分析2012年1月至2017年12月苏州高新区人民医院手足外科应用近节指背筋膜蒂逆行岛状皮瓣修复指端缺损30例(30指)，其中男性24例，女性6例；年龄19 ～ 58岁，平均(36±12)岁。其中指腹缺损伴指骨外露12例，指尖皮肤软组织伴甲床远端及末节指骨远端少量缺损8例，指尖皮肤及甲床缺损5例，甲床大部分缺损伴末节指骨远端少量缺损5例。创面缺损范围为3.0 cm×1.5 cm ～ 2.0 cm×0.5 cm。按照指端缺损面积设计皮瓣大小，皮瓣蒂部为指桡背侧或尺背侧筋膜组织，旋转点最远不超过远指间关节平面，旋转皮瓣及蒂部180°逆行修复指端缺损，供区全厚皮片游离移植修复。术后对皮瓣外形、感觉和手功能恢复等指标进行观察评价。 结果术后30例(30指)皮瓣25指顺利成活，5指术后起张力性水泡，拆线换药后表皮脱痂愈合。术后随访2～12个月，皮瓣修复外观及质地良好，患者对皮瓣及伤指外观满意，患指屈伸功能恢复良好，皮瓣感觉两点辨别率为4～12 mm。 结论近节指背筋膜蒂逆行岛状皮瓣血供明确，切取灵活方便，不牺牲指固有动脉，是修复指端缺损的一种理想方法。

Treatment effectof application of retrograde dorsal island fasciocutaneous flap for repairing fingertip defects

ObjectiveTo report the effect of the reverse island flap with the proximal dorsal phalangeal fascial pedicle for repairing fingertip defects. MethodsA retrospective analysiswas made to 30 cases (30 fingers) with fingertip defects applied withthe reverse island flap with the proximal dorsal phalangeal fascial pedicle in the Hand And Foot Surgery department of Suzhou New District People’s hospital from January 2012 to December 2017including 24 males and 6 females, Aged from19 to 58 years old, average (36±12) years old. Among them, there were 12 cases of finger defect with bone exposure, 8 cases of finger skin soft tissue with distal nail and distal end of phalanx, 5 cases of fingertip skin and nail bed defect, 5 cases of more of nail bed defect with less amount of distal phalanx defects. The area of wound defect rangedfrom 3.0 cm×1.5 cm to 2.0 cm×0.5 cm.The design of skin flap is according to the defective area of fingertip .The flap pedicle is made of the radial or ulnar side of the dorsal phalangeal fascia tissue. The rotation point is not far away from the distal phalangeal joint plane. The flap pedicle was retrograded at 180 degree for repairing the fingertip defect. The donor site was repaired with free skin graft. Results30 cases of 30 finger flaps were repaired after the operation. Among them, 25 fingers survived smoothly, 5 fingers had tension blisters after the operation, but the skin healed after dressing changing and the thread removing. During the follow-up 2 -12 months after the operation, the skin flaps had good appearance and texture, and the appearance of the flap and the finger was satisfied by the patients, and the flexion and extension function of the fingers recovered well. The two-point discrimination rate of the flap was 4 to 12 mm. ConclusionThe blood supply of the clinical effect of the reverse island flap with the proximal dorsal phalangeal fascial pedicle is clear and the cutting of the flat is flexible and convenient without sacrificing the proper digital artery, it is an ideal method to repair fingertip defects.