拇指皮肤缺损的早期显微外科修复

目的 报道应用不同类型的皮瓣修复拇指皮肤软组织缺损的临床疗效。方法 对43例拇指皮肤缺损患者，急诊应用7种方法治疗。其中拇指掌侧推进皮瓣8例，示指近节背侧岛状皮瓣15例，第一掌背逆行筋膜皮瓣4例，中、环指邻侧双岛状皮瓣3例，桡动脉鼻烟窝皮支逆行岛状皮瓣5例，带骨间后动脉的前臂逆行岛状皮瓣4例，mu趾甲皮瓣游离移植4例。结果 本组43例中，坏死1例，改用其它皮瓣修复；部分坏死2例，经换药痊愈。其余40例拇指外形较好，指腹感觉存在，活动正常或稍差于健侧，拇指能与2～5指对指。结论 不同程度的拇指皮肤缺损选用合适的方法修复，疗效可靠。

Early microsurgical repair of thumb skin defect

Objective To report the clinical therapeutic effects of different types flaps for repairing thumb skin soft tissue defect. Methods We repaired 43 cases with thumb skin defect by seven methods: 8 cases by palmer propulsive flap of the thumb,15 cases by dorsal island flap of the proximal index finger,4 cases by reverse fascial flap of first dorsal metacarpal, 3 cases by double island flap of middle and ring finger, 5 cases by reverse island flap with the nasopharyngeal fossa cutaneous branch of the radial artery,4 cases by reverse forearm island flap with posterior interosseous artery,and 4 cases by free thumb-nail flap grafting. Results In the group, 1 case was necrotic and repaired by other flap, 2 cases were partially necrotic and healed through dressing change. The rest 40 cases had good appearance,thumb pad sensation,normal activity or slightly poorer than that of the healthy, and could make thumb movement by 2nd-5th fingers. Conclusion Thumb skin defects of varied degrees can be repaired by selecting rational methods, and get a reliable therapeutic effect.