掌背动脉逆行岛状皮瓣修复手指掌侧软组织缺损的感觉功能随访研究

背景:目前临床对掌背动脉逆行岛状皮瓣的研究报道较多,随访着重在皮瓣的成活、外形质地、手指屈伸活动等方面,缺少对感觉恢复的系统测定。目的:观察掌背动脉逆行岛状皮瓣修复手指掌侧软组织缺损的感觉恢复情况。方法:回顾性分析2015年1月至2017年12月收治的采用掌背动脉逆行岛状皮瓣修复的手指掌侧软组织缺损患者22例,其中6例采用皮瓣内的掌背神经和指固有神经缝合。术后1、3、6、9、12、18、24个月随访患者深压痛觉、单丝触觉、两点辨别觉恢复情况。结果:所有患者均在止血带下顺利完成手术。术后20例皮瓣完全成活,2例皮瓣远端少部分坏死,经换药处理后愈合。随访时间24~30个月,平均(24.5±0.3)个月。术后1个月22例患者深压痛觉均恢复;末次随访感觉恢复评价达S3:3例,S2:18例,S1:1例,末次随访两点辨别觉测定均大于20mm。随访患者中最长一例随访30个月,末次随访感觉测定S3,两点辨别觉测定大于20mm。该例患者感觉恢复在术后18个月以后基本无变化。结论:掌背动脉逆行岛状皮瓣修复手指掌侧软组织缺损的深压痛觉在术后1个月就能恢复;感觉恢复能达到S3,达S3+困难;无法恢复两点辨别觉。对一些特殊行业、对指掌侧感觉要求较高的手指掌侧缺损患者慎重应用。

A follow-up of sensory reconstruction in palmar soft tissue defect repaired by retrograde island flap of dorsal metacarpal artery

Background:There are many researches on the retrograde island flap of the dorsal metacarpal artery in aspect of flap survival,appearance and texture,the flexion and extension of fingers,but there is a lack of systematic measurement of sen sory reconstruction.Objective:To observe the sensory reconstruction of the palmar soft tissue defect repaired by the retrograde island flap of the dorsal metacarpal artery.Methods:Twenty-two patients with palmar soft tissue defects repaired by a retro grade island flap of the dorsal metacarpal artery from January 2015 to December 2017 were retrospectively analyzed.The pal mar proper digital nerves were sutured in 6 patients.Deep pressure pain,monofilament touch,and two-point discrimination(2-PD)were evaluated at 1,3,6,9,12,18 and 24 months after surgery.Results:The operation was successfully done in all the patients with the use of tourniquet.The flap survived completely in 20 patients.The necrosis was found at the distal end of the flap in 2 patients,which were healed after dressing change.The mean duration of follow-up was(24.5±0.3)months(range,24-30 months).All the 22 patients had deep pressure pain at 1 month after surgery.At the last follow-up,sensory reconstruction reached S3 in 3 cases,S2 in 18 cases,and S1 in 1 case;2-PD determination were greater than 20 mm.In the patient with the longest follow-up period of 30 months,at the final follow-up,the result of sensory measurement was S3,and 2-PD measure ment was greater than 20 mm,which were no changes since 18 months postoperatively.Conclusions:The deep-pressure pain can appear at one month after soft tissue repair with the retrograde island flap of the dorsal metacarpal artery.The sensory re construction can reach S3,but it is difficult to surpass S3.The result of 2-PD measurement is below standard.The operation should be used cautiously in those patients with high requires of palmar sensation in some special industries.