吻合指固有神经背侧支的邻指皮瓣修复手指远端掌侧软组织缺损

目的探讨采用吻合指固有神经背侧支的邻指皮瓣修复手指远端掌侧软组织缺损的疗效. 方法 1996年10月～2004年6月,25例(32指)伴肌腱或骨组织外露的手指远端掌侧软组织缺损患者,其中男18例,女7例,年龄13～45岁.切割伤6例,冲压伤8例,机器绞伤11例.损伤部位:拇指2例,食指8例,中指5例,环指3例,小指2例,食、中指2例,中、环指2例,食、中、环、小指1例.缺损范围:1.5 cm×1.0 cm～4.0 cm×2.1 cm.损伤至就诊时间30 min～48 h.急诊行清创,采用带蒂邻指皮瓣修复,术中同时将指固有神经的背侧支与指神经残端吻合重建皮瓣感觉,术后3周断蒂.供区中厚皮片游离植皮. 结果术后皮瓣及供区均成活,创面Ⅰ期愈合.获随访6～26个月,手指指腹饱满,色泽正常,感觉恢复,两点辨别觉为5～8 mm,均无功能障碍. 结论采用吻合指固有神经背侧支邻指皮瓣修复手指远端掌侧软组织缺损不仅能修复缺损皮肤,且能重建皮瓣感觉,术式操作简便.

REPAIR THE PALMAR SOFT TISSUE DEFECT OF THE FINGER WITH CROSS-FINGER FLAP WITH CUTANEOUS BRANCH OF THE ULNAR DIGITAL FINGER

OBJECTIVE: To discuss the clinical effect of cross-finger flap with cutaneous branch of the ulnar digital finger on repairing the palmar soft tissue defect of the finger. METHODS: From October 1996 to June 2004, cross-finger flaps were used to repair the palmar soft tissue defect of the finger in 25 cases (32 fingers ) with tendon or bone exposed. There were 18 males and 7 females, and their ages ranged from 13 to 45 years. Among them, 6 cases were incised injury, 8 cases were impact and press injury, 11 cases were crush injury; and 2 cases were thumb, 8 cases were index, 5 cases were middle finger, 3 cases were ring finger, 2 cases were little finger, 2 cases were index and middle finger, 2 cases were middle and ring finger, and 1 cases were index, middle, ring and little finger. The time from injury to diagnosis was 30 min to 48 h, and the size of the tissue defect was 1.5 cm x 1.0 cm to 4.1 cm x 2.0 cm. All cases were treated with emergent operation, and the sense of the flap was recovered by anastomosing the cutaneous branch of the ulnar digital finger and the distal digital nerve of injured finger. The flap pedicle was dissected 3 weeks later. RESULTS: Follow-up was conducted for 6 to 26 months and it showed that the cross-finger flaps all survived with full digital fingertip, satisfactory appearance, good function, and normal sense. The discrimination of two points was 5-8 mm. CONCLUSION: As it is easy to operate and with satisfactory appearance and good function restoration, cross-finger flap with cutaneous branch of the ulnar digital finger is effective in repairing the palmar soft tissue defect of the finger.