改良示指背侧岛状皮瓣一期修复拇指末节缺损的临床效果分析

目的分析改良示指背侧岛状皮瓣技术在一期修复拇指末节缺损中的应用价值及临床效果。方法采用随机数字表法选择宜宾第一人民医院122例拇指末节缺损的患者,均因机械伤或重物砸伤等因素导致。根据选用皮瓣的不同将其分为示指皮瓣组65例,拇指皮瓣组57例。示指皮瓣组男性44例,女性21例;年龄24~49岁,平均38.4岁;缺损范围1.2cm×1.0cm~2.6cm×2.3cm,受伤至手术时间平均2.8h;拇指皮瓣患者男性41例,女性16例;年龄23~50岁,平均38.2岁;缺损范围1.3cm×1.1cm~2.5cm×2.2cm,受伤至手术时间平均2.6h。示指皮瓣组采用的治疗技术为改良示指背侧岛状皮瓣一期修复,拇指皮瓣组患者采用拇指桡背侧岛状皮瓣修复。手术结束后护理和随访时间8~12个月,对比两组患者皮瓣生存情况以及拇指外观、功能和感觉等。结果示指背侧岛状皮瓣和拇指皮瓣成活率均达到100%,创面一期愈合。示指背侧岛状皮瓣颜色红润,外观饱满,质地良好,与受区相差不大;拇指皮瓣皮温正常,血供较好,但有明显臃肿,可明显辨别两者差距。根据总关节活动度(TAM)功能评分,示指皮瓣组(14.9531±1.6948)功能明显好于拇指皮瓣组(5.6985±0.8492),差异有统计学意义(P0.05)。对比两组患者皮瓣两点辨别觉,示指皮瓣组平均(4.9534±0.4325)mm,明显好于拇指皮瓣组的(15.8435±1.5914)mm,差异有统计学意义(P0.05)。结论拇指末节损伤后采用改良示指背侧岛状皮瓣一期修复的效果显著,皮瓣成活率高,外观与受区相似,功能和感觉均有改善,在临床应用中具有较高的实用价值,值得推荐。

Analysis of the effect of modified forefinger dorsal island flap for repair of distal thumb defect

Objective To analyze the effect of modified forefinger dorsal island flap for repair of distal thumb defect.Methods A total of 122 patients with thumb defect treated in the First People`s Hospital of Yibin were selected according to the random number table method.All were resulted from mechanical injury or bruise.They were divided into forefinger skin flap group (65 cases) and thumb skin flap group(57 cases) according to different flaps.Patients in the forefinger skin flap group included 44 males and 21 females aged from 24-49 (average,38.4) years,with the defect size of 1.2cm×1.0cm-2.6cm×2.3cm and the injury to operation time of 2.8h.Patients in the thumb skin flap group included 41 males and 16 females aged from 23-50 (average,38.4) years,with the defect size of 1.3cm×1.2cm-2.5cm×2.2cm and the injury to operation time of 2.6h.The forefinger skin flap group was given modified index finger dorsal island flap and the thumb skin flap group was given dorsal island flap of thumb.They were given postoperative care and follow-up of 8-12 months.The survival condition,appearance,function and sensation of skin flaps were compared between the two groups.Results The survival rate of the forefinger dorsal island flap and the thumb flap reached 100% of primary-stage healing.The forefinger dorsal island flap color was ruddy with plump appearance and good texture,with little difference in the donor area;the thumb flap had normal good blood supply,but there was an obvious bulk,and the difference between the two groups was significantly distinguished.The total joint mobility(TAM) functional score of the forefinger skin flap group(14.9531±1.6948) was higher than that of the thumb skin flap group(5.6985±0.8492,P<0.05).The two point discrimination of the forefinger skin flap group(4.9534±0.4325)mm was better than that of the thumb skin flap group(15.8435±1.5914)mm (P<0.05).Conclusion Distal thumb injury repaired with modified index finger dorsal island flap can achieve high survival rate,similar appearance to the affected area and improved feeling.It has high practical value in clinical applications,and it is worthy to be recommended.