重建感觉的指动脉背侧支逆行岛状皮瓣与指动脉逆行岛状皮瓣修复手指指端缺损效果比较

目的：比较重建感觉的指动脉背侧支岛状皮瓣与指动脉逆行岛状皮瓣两种手术方法修复指端缺损的效果，为临床选择提供参考。方法自2012年8月～2013年9月，选择本科2～4指甲弧以远的复合组织缺损，指腹单纯软组织缺损者，采用重建感觉的指动脉背侧支逆行岛状皮瓣修复17例（20指）或指动脉逆行岛状皮瓣修复14例（16指），比较手术时间，术后皮瓣情况，随访两组皮瓣两点感觉，受区、供区外观及患指活动度等。结果①指动脉背侧支皮瓣组手术时间平均为78．6min，指动脉皮瓣组45min，两者比较有显著差异（P＜0．01）；②指动脉背侧支皮瓣中有3例（3指）发生血管危象，指动脉皮瓣组中1例（1指）发生静脉回流障碍；③术后12个月时测量两组皮瓣静态两点辨别觉，指动脉背侧支皮瓣组6．2～10．4mm，平均8．3mm，指动脉皮瓣组8．5～12．4mm，平均10．45mm；④指动脉皮瓣组中术后患指怕冷、严寒疼痛现象发生率高于指动脉背侧支组。结论与指动脉岛状皮瓣相比，指动脉背侧支皮瓣可较好地重建指端感觉，应用效果较为满意。

The Comparison of Effectiveness of Reverse Island Flap Pedicled with Dorsal Cutaneous Branches of Digital Internal Artery with Sense Reconstruction and Reversed Digital Artery Island Flap for Repairing Fingertip Soft Tissue Defects

Objective Providing options for clinicians through compare the effectiveness of reverse island flap pedicled with dor -sal cutaneous branches of digital internal artery with sense reconstruction and reversed digital artery island flap for repairing fingertip soft tis -sue defects.Methods From August 2012 to September 2013,patients with composite tissue defects beyond the lunula or pure pulp soft tissue defects in 2~4 fingers were treated.There were 17 cases（20 fingers） treated with reverse island flap pedicled with dorsal cutaneous branches of digital internal artery with sense reconstruction and 14 cases（16 fingers） treated with reversed digital artery island flap ,then compare the operation time,flap recovery,the two-point discrimination,the norma of donor and recipient sites and the function of trigger finger ,etc.Results①The average operation time ,the group of island flap pedicled with dorsal cutaneous branches of digital internal artery was 78.6 minutes, while the group of digital artery island flap was 45 minutes,there were significant differences between them （P〈0.01）;②Vascular crisis oc-curred in 4 cases（4 fingers） in island flap pedicled with dorsal cutaneous branches of digital internal artery ,vein drainage disturbance oc-curred in 1 case（1 finger） in eversed digital artery island flap;③After 12 months of operation ,the two-point discrimination of the group of is-land flap pedicled with dorsal cutaneous branches of digital internal artery was 6.2~10.4mm（average,8.3mm）,while the group of digital artery island flap was 8.5~12.4mm（average,10.45mm）;④The incidence of the phenomenon that finger pain when subjected to cold was higher in roup of island flap pedicled with dorsal cutaneous branches of digital internal artery than the group of digital artery island flap .Con-clusion The island flap pedicled with dorsal cutaneous branches of digital internal artery can reconstruct the perception of finger tip very well and the application effect is satisfactory than the group of digital artery island flap .