拇指指腹缺损修复方法的临床研究

目的研究拇指指腹缺损的修复方法。方法109例拇指指腹缺损的病例，应用掌短肌皮瓣修复18例，应用拇指尺背侧皮神经营养血管皮瓣修复26例，应用示指背侧皮瓣修复30例，应用腹股沟皮瓣修复35例。结果所有皮瓣全部成活。95例经过10个月～11年随访，从皮瓣色泽、质地、外形、感觉等方面分析，以掌短肌皮瓣色泽及质地最接近拇指指腹，皮瓣两点分辨率达5mm—11mm，平均7．3mm；拇指尺背侧皮神经营养血管皮瓣及示指背侧岛状皮瓣色泽、质地与拇指指腹接近，感觉恢复为10mm～12mm，平均11．2mm；腹股沟皮瓣组织修复后色泽较深，质地较拇指指腹薄、软，两点分辨率为12mm～16mm，平均13．6mm。结论掌短肌皮瓣修复后色泽、质地最为理想、外形最好，感觉恢复最佳，但手术最复杂；拇指尺背侧皮神经营养血管皮瓣及示指背侧皮瓣修复后色泽、质地与拇指指腹接近，感觉有一定恢复，手术仍有一定风险；腹股沟皮瓣修复术后常见色素沉着，质地与拇指相差较大，感觉恢复差，但手术简单，易于开展。

Clinical Research on Reconstruction of Pulp Defects of Thumb

Objective To study the method for reconstruction of pulp defects of thumb. Methods Out of the 109 cases with pulp defects of thumb, 18 cases were repaired by palmaris brevis musculocutaneous flaps,26 cases were reconstructed by reversed neuro-cuhaneous flaps on dorsal-ulnar side of thumb, 30 cases were repaired by dorsal metacarpal flaps of index finger, and 35 cases were repaired by groin flaps. Results All flaps survived.95 cases were followed up for a period of 10 months to 11 years so as to study the color, texhare,shape and sensory recovery, and palmaris brevis musculocutaneous flaps showed the best color texture and outer shape recovery, 2- PO reached 5-11mm with the average of 7.3mm, the neurocutaneous flaps on dorsal-ulnar side of thumb and dorsal metacarpal flaps were close in color, shape and texture compared with the original thumb pulp and 2-PO reached 10 - 12mm with the average of 11.2mm, groin flaps were deep in color and soft and thin in texture and 2-PO reached 12 - 16mm with the average of 13.6mm. Conclusion The palmaris brevis musculocutaneous flaps may produce best recovery in color, texture, shape and 2-PO, but flap transferring is the most compfieated;the reversed neuro-cutaneous flaps on dorsal-ulnar side of thumb and the dorsal metacarpal flaps of index finger are close in color, texture, outer-shape compared with the original thumb and sensory recovery may be gained at certain degree, but there is certain danger in flap necrosis. The groin flap is deep in color and soft and thin in texture while sensory recovery is unsatisfactory, but the operation performance is the simplest.