手指软组织缺损的逆行岛状皮瓣修复

目的报道手指软组织缺损几种岛状皮瓣修复的方法和临床应用效果。方法应用指动脉、掌背动脉和指神经背侧支逆行岛状皮瓣修复手指软组织缺损39例45指，其中7例7指应用指动脉逆行岛状皮瓣修复末节软组织缺损；22例28指应用指神经背例支逆行岛状皮瓣。修复中、远节软组织缺损；10例10指应用掌背动脉逆行岛状皮瓣修复手指掌、背侧近节或超近节以上较大面积缺损。后32例中23例吻合神经。结果本组39例随访6～12月，皮瓣血运、质地及功能良好，皮瓣供区无功能障碍。指动脉逆行岛状皮瓣较其它两种皮瓣外形明显臃肿且感觉差。缝合神经的23例皮瓣两点分辨觉为6～8mm，未缝合神经的皮瓣由于受区神经的长入也有了保护性感觉功能。结论临床应根据不同节段的手指软组织缺损而选择不同的岛状皮瓣修复。

Repair of soft tissue defects of fingers with the reverse island skin flap

Objective To report the clinical effect of several kinds of island flap in repair of soft tissue defect of fingers. Methods 39 cases （45 fingers）with soft tissue defect in the maniphalanx were repaired by three methods, of whom 7 cases （7 fingers） with soft tissue defect of paratelum of fingers were repaired by reverse island flap pedicle of digital artery, 22cases （28 fingers） with soft tissue defect of middle and distal segment of fingers were repaired by reverse insular fascial flap with dorsal branch from the proper digital nerve,10 cases （10 fingers）with larger area soft tissue defect of proximal fingers were repaired by reverse dorsal metacarpal artery island flap. The cutaneous nerve of 23 cases in the last 32 cases was anastomosed. Results All cases were followed-up for 6 to 12 months, the blood circulation, texture and function of flaps were satisfactory. The sensory disability and clumsy appearance of reverse island flap pedicle of digital artery were more conspicuous comparing with the other two flaps. The two-point discrimination of 23 cases with cutaneous nerve anastomosis was 6 ~ 8mm, the other cases without nerve anastomosis obtained protective sensation depending on newbomed nerve from recipient site. Conclusion Different .reverse island flap should be adopt in restoration of soft tissue defect in different segment of finger.