带掌背神经的腕掌背侧逆行岛状皮瓣再造手指的临床应用

目的探讨带掌背神经的腕掌背侧逆行岛状皮瓣再造手指的临床效果。方法设计有2条相邻掌背动脉供血,带掌背神经的腕、掌背侧逆行岛状皮瓣,利用废弃手指的骨肌腱支架或游离髂骨移植,再造有感觉的手指。结果再造手指18例,其中3例是手指脱套伤,获得成功,切取皮瓣最大面积达9cm×8cm。18例术后随访3个月-2年,术后7周左右再造手指的痛觉恢复,感觉在S3以上者为89%,其两点分辨觉为5～10mm。术后再造手指外形满意,感觉恢复接近正常,运动功能恢复可完成日常活动。结论应用带掌背神经的腕掌背侧逆行岛状皮瓣手术简单实用,成活率高,损伤小,术后的手指有感觉,外形较好。

Clinical application of dorsal carpometacarpal reversed island flap with dorsal metacarpal nerve to reconstruct finger

Objective To investigate the clinical effect of dorsal carpometacarpal reversed island flap with dorsal metacarpal nerve to reconstruct finger. Methods We designed the dorsal reverse carpal and metacarpal island flaps with nerve by using the adjacent two dorsal matacarpal arteries as blood-supply and applied the stand of bone and tendon in waste finger or the free iliac transplantation to reconstruct the every sensory finger. Results Eighten cases were survived completely, and the skin degloving injuries of the finger in 3 cases. The maximum of the flap was 9cm by 8cm. Patients were followed up 3 months to 2 years,7 weeks later pain sense of reconstructed finger was recovered. Sensation over S3 amounts to 89% of the digits. Two-point-discrimination of the digits was 5-10mm. After the operation, the reconstructed finger obtained good appearance, the sensory recovery approach normally. The patients have ability to fulfil daily activities. Conclusion This method has advantages as follow:simple and practical,high survive rate,low impairment,sensible and good appearance.