拇指指端皮肤软组织缺损的岛状皮瓣修复

目的探讨拇指末节皮肤软组织缺损岛状皮瓣修复的临床疗效。方法从2009年4月至2011年6月，对收治的45例（45指）拇指指端皮肤软组织缺损的患者分别采用示指背侧顺行岛状皮瓣、拇指尺背侧逆行岛状皮瓣、虎口背侧逆行岛状皮瓣、大鱼际桡侧逆行岛状皮瓣和指动脉侧方神经血管蒂岛状皮瓣等5种岛状皮瓣修复。通过术后随访，比较各种皮瓣的治疗效果、治疗优缺点和最佳适应损伤类型。结果45例皮瓣全部成活，植皮区I期愈合。术后1例虎口背侧逆行岛状皮瓣和1例拇指尺背侧逆行岛状皮瓣远端皮缘部分坏死，经伤口换药后，均成活。所有患者均获得随访，随访时间6—24（15．7±2．1）个月，末次随访时，皮瓣外观恢复满意，质地柔软，弹性好，未见明显色素沉着，拇指活动、对掌功能及皮肤感觉均恢复良好。结论拇指尺背侧逆行岛状皮瓣、虎口背侧逆行岛状皮瓣、大鱼际桡侧逆行岛状皮瓣和指动脉侧方神经血管蒂岛状皮瓣是修复拇指指端缺损的有效方法，临床治疗各有优点，临床可根据拇指皮肤缺损特点，选择最佳皮瓣治疗。

Various island flaps for repairing subtotal soft tissue defect of the thumb

Objective To explore the clinical effects of various island flaps in the repairing the subtotal soft tissue defect of the thumb. Methods Between April 2009 and June 2011, 45 patients with soft tissue defect of the thumb according to injuries were treated with index finger dorsal anterograde island flap, thumb ulnar dorsal retrograde island flap, thumb web space dorsal retrograde island flap, thenar radial iateral retrograde island flap, the side of the inherent neurovascular island flap to cover the soft tissue defect of the thumb, respectively. Clinical effects, advantages, disadvantages, and the best of surgical indications were compared with the repairing of the thumb partial defect according to the clinical follow-up. Results All 45 flaps were survived, and the dermatoplasty of donor site was primarily healing . One case of dorsal first web space flap and one case of thumb ulnar dorsal retrograde island flap appeared postoperatively partial necrosis, and were healed after dressing change. Postoperative follow-up time ranged from 6 to 24 months, with an average of （ 15.7 ± 2. 1 ） months. The flaps had satisfactory appearance, good texture, and color match. The movement of the thumb, including its opposition and sensation, were all good regained. Conclusions Application of the index finger dorsal island flap, thumb ulnar dorsal retrograde island flap, thumb web space dorsal retrograde island flap, thenar radial lateral retrograde island flap, or the inherent neurovascular island flap to repair of thumb of partial defect was effective with their own distinctive advantage. One should find the relatively ideal appropriate treatment according to the different clinical point of the thumb defect.