改良邻指矩形皮瓣修复手指末节套状撕脱皮肤缺损

 目的 探讨改良切取指动脉背侧支供血的邻指超比例矩形皮瓣修复手指末节套状撕脱皮肤缺损的手术方法及临床疗效。
方法 2006年1月至2010年3月，收治26例（26指）手指末节套状撕脱皮肤缺损患者，男21例（21指），女5例（5指）；年龄17～56岁，平均31.6岁；机器绞伤14例，挤压伤8例，绳索绞勒伤4例。其中示指8例，中指9例，环指4例，小指5例。脱套手指末节长度为1.1～2.6cm。应用指动脉背侧支供血的邻指超比例矩形皮瓣修复，皮瓣切取范围3.6cm×2.3cm～6.5cm×3.2cm。供区全厚皮片游离移植。
结果 术后13~23d断蒂，26例皮瓣全部成活，皮瓣及供区植皮伤口均一期愈合。术后25例获得随访，随访时间6～28个月，平均16.3个月。皮瓣质地柔软，外观饱满。两点辨别觉为6～9mm，平均7.8mm。无一例外观表现臃肿及发生指端触痛等并发症。手功能按手指总主动活动度（total active movement，TAM）法评定，优17例，良7例，可1例，优良率为96%。
结论 改良切取指动脉背侧支供血的邻指超比例矩形皮瓣修复手指末节套状撕脱皮肤缺损的方法操作简单，皮瓣成活率高，术后手指功能恢复满意，皮瓣外观及感觉恢复良好，可用于修复2~5指末节套状撕脱皮肤缺损。

Modified rectangle cross-finger flap to repair degloved avulsion of fingertip

Objective To investigate the operative procedure and the clinical result of the modified rectangle cross-finger flap based on the dorsal branches in the middle phalange to repair degloved avulsion of fingertip.Methods From January 2006 to March 2010,26 patients with the avulsions of fingertip were treated by the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange of adjacent finger.There were 21 men and 5 women,with an average age of 31.6 years(range,17-56 years).Fourteen cases were crushed by machine,8 cases were pressed and 4 cases were tied.There were 8 index fingers,9 long fingers,4 ring fingers and 5 little fingers.The length of the avulsion was 1.1-2.6 cm.The flap was harvested from the dorsal of contiguous digital of their middle and proximal segment.The both dorsal branches of the both proper palmar digital nerves were cut off and were anatomized with the nerve end of the injured digit.The area of flaps ranged from 3.6 cm×2.3 cm-6.5 cm×3.2 cm.The donors were closed by skin graft.Results The pedicels were cut when 13-23 d after operation.Twenty-five patients were followed up for 6-28 months(mean,16.3 months).All flaps survived with satisfactory appearance,sensation and function.All flaps and donors were primary healing.Two point discrimination was 6-9 mm with an average of 7.8 mm.The postoperative outcomes were evaluated by the total active movement.The results were excellent in 17fingers,good in 7,and fair in 1.The rate of excellent and good was 96%.Conclusion The treatment of degloved avulsion of fingertip with the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange is recommendable.The operative procedure of harvesting the flap is simple.There is enough blood to supply the flap and the surviving rate is high.The postoperative function of the injured hand can be recovered satisfactorily.The figure of flap is well and the sense of flap is sensitive.The technique can be operated in the last 4 fingers without thumb.