拇指背动脉岛状皮瓣的临床应用及血供障碍处理

目的：介绍拇指背动脉岛状皮瓣修复拇指软组织缺损的临床经验,并探讨血供障碍的原因及处理方法。方法：自2005年7月至2008年12月,外科治疗21例21指拇指软组织缺损,男16例,女5例;年龄16～55岁,平均39岁。应用拇指背桡侧动脉岛状皮瓣修复拇指远节桡侧软组织缺损（4例）,拇指背尺侧动脉岛状皮瓣修复拇指尺侧、指腹及甲床缺损（17例）,皮瓣旋转点指间关节近侧0.5cm,皮瓣面积2cm×1.5cm～4cm×2.5cm。结果：术中术后6例发生血供障碍,经对应处理皮瓣无坏死。随访3个月～2年,皮瓣质地优良,色素沉着轻度,外形满意,拇指掌指关节及指间关节活动范围正常。修复指腹者感觉不同程度恢复,两点辨别觉：4～10mm。结论：拇指背动脉岛状皮瓣修复拇指软组织缺损方法简单,效果满意。蒂部长度、宽窄及受压均能影响皮瓣的血供,蒂部处理是治疗成功的关键。

Clinical application of island skin flap of pollical dorsal digital arteries in repairing defect of soft tissue

Objective: To introduce clinical experience of repairing defect of pollical soft tissue with island skin flap of pollical dorsal digital arteries,and explore the reasons of disturbance of blood supply and its therapeutic method. Methods: From July 2005 to December 2008,21 thumbs in 21 patients with defect of soft tissue were treated with surgery. There were 16 males and 5 females,ranging in age from 16 to 55 years with an average of 39 years. Defects of extremity-radialis soft tissues of thumb in 4 cases were repair with island skin flap of dorsal-radial pollical arterial;and defects of ulnaris,finger pulp,hyponychium of thumb in 17 cases were repair with island skin flap of dorsal-ulnar pollical arterial. The pivoting point of flap was 0.5 cm proximal to interphalangeal joint. The size of flap was from 2 cm×1.5 cm to 4 cm×2.5 cm. Results: Blood articulo was found in 6 cases during operation and after operation and the flaps survived after corresponding treatment. The patients were follow-up from 3 months to 2 years. The texture and shap of flap was good,only had slightly pigmentation. Range of motion was normal in metacarpophalangeal joints and interphalangeal joint. All the flaps of prothetic finger pulp had sensory recovery with two point discrimination for 4-10 mm. Conclusion: It is easy and effective in repairing defect of pollical soft tissue with island skin flap of pollical dorsal digital arteries. The treatment of pedicle is key to success,the length,width and compression of pedicle can effect on blood supply of flap.