指固有动脉不同节段背侧皮支为蒂的岛状皮瓣修复同指皮肤缺损

目的 探讨以指固有动脉不同节段背侧皮支为蒂的岛状皮瓣修复同指皮肤及软组织缺损的临床效果.方法 2005年6月至2008年6月,对45例52指手指皮肤缺损的患者,采用以指固有动脉背侧皮支为蒂的岛状皮瓣转移修复.结果 45例中除4指皮瓣远端部分坏死外,其余皮瓣全部成活,经4～8个月随访,功能及外观良好.吻合神经皮瓣的两点辨别觉为6.0～9.0 mm,平均7.4 mm.未吻合神经的皮瓣的两点辨别觉为8～10 mm,平均9 mm.植皮区无明显凹陷,5指轻度色素沉着,4指出现植皮边缘瘢痕挛缩,其中1指远侧指间关节约10°伸直受限,经理疗后未见缓解.2指出现供区瘢痕触痛,经理疗后部分缓解.在常温下和冰水中均未出现苍白、发凉.供指指腹感觉均为S_4.手功能按ATM法,优42指,良7指,可3指,优良率达92%.结论 该术式不损伤手指的主要动脉,是治疗手指皮肤缺损的一种可行的手术方法.

Application of island flap pedicled with dorsal cutaneous branches of digital internal artery for skin defect at the same finger

Objective To investigate the therapeutic effect of island flap pedicled with dorsal cutaneous branches of digital internal artery for skin defect at the same finger. Methods From June 2005 to June 2008, 52 fingers in 45 cases with skin defects were treated with island flap pedicled with dorsal cutaneous branches of digital internal artery for skin defect at the same finger. Results Partial necrosis happened at the distal end of 4 island flaps. All the other flaps survived completely. The patients were followed up for 4-8 months with satisfactory cosmetic and functional results. The two-points discrimination distance was 6. 0-9.0mm ( average, 7.4 mm) in flaps with nerve anastomosis, and 8-10 mm (average, 9mm) in flaps without nerve anastomosis. Minor pigmentation occurred in 5 fingers, cicatricial contracture around the skin graft in 4 fingers, and pain in donor site scar in 2 fingers. The hand function was assessed as excellent in 42 fingers, as good in 7 fingers and medium in 3 fingers. Conclusions The main artery will not be sacrified when the island flap is used. It is ideal for the treatment of finger skin defect.