不同带蒂皮瓣修复拇指软组织缺损的临床研究

目的 探讨修复拇指软组织缺损的最佳手术方式. 方法 自2006年8月至2008年3月对37例拇指软组织缺损伴骨外露或Ⅰ类拇指缺损者进行手术修复.37例患者中,以拇指桡背侧动脉为蒂的皮瓣修复15例,指腹推进皮瓣修复5例,示指背侧皮瓣修复6例,桡动脉皮瓣修复2例,以拇指尺背侧动脉为蒂皮瓣修复9例.其中拇指尺、桡背侧动脉皮瓣的设计以拇指尺、桡背侧动脉体表投影线为轴心线,拇指桡、尺侧纵轴线上距甲沟(2.2±0.2)cm处为旋转点,皮瓣面积最大可达3.5 cm×4.5cm.结果 术后37例皮瓣全部成活.术后随访3～12个月,平均(5.0±0.8)个月.拇指桡、尺背侧动脉皮瓣修复组拇指外形大部分满意,指腹二点分辨觉为5～10 mm,指间关节活动范围为0～70°,由于吻合了桡神经分支与指神经末端,皮瓣术后恢复S_2以上感觉百分比达86.7%、66.7%.结论 拇指桡背侧动脉皮瓣是修复拇指软组织缺损的较佳选择,全拇指脱套伤在特殊情况下则可以考虑应用桡动脉皮瓣.

Repair of thumb soft tissue defects with different pedicle flaps

Objective To discuss the clinical outcomes of different pedicle flaps used for thumb soft tissue defects. Methods Between August 2006 and March 2008, we repaired 37 cases of soft tissue defects and bone exposure of the thumb. Of them, 15 were repaired with the dorsoradial arterial retrograde flap, 5 with the pulp advancement flap, 6 with the dorsal aspect of the index finger flap, 2 with the radial artery retrograde flap, and 9 with the dorsoulnar arterial retrograde flap. The surface projective line of the dorsoulnar or dorsoradial artery of the thumb was made the axial line of the dorsoulnar or dorsoradial arterial retrograde flap, and the vertical line across the perforating branch of dorsal artery 2. 2±0. 2 cm from the nail groove was made the rotation point. The area of the flap was as large as 3.5 cm×4. 5 cm. Results All the 37 flaps survived. They were followed up for 3 to 12 (average, 5. 0±0. 8) months postoperatively. The appearance of the thumb was satisfactory. The pulp two-point discrimination was 5 to 10 mm and the range of motion at the interphalangeal joints of the thumb was 0 to 70° Conclusion The dorsoradial arterial retrograde flap of the thumb is a good choice for the thumb soft tissue defects, and the radial artery retrograde flap can be used for degloving injury of the thumb.