吻合指神经的指动脉逆行岛状皮瓣修复指腹缺损

目的：报道吻合指神经的指动脉逆行岛状皮瓣修复指腹缺损的解剖学基础及其临床应用。方法：对20具成人尸体40例手的指掌侧固有神经直径和分支进行了测量；并对39例患者的39指指腹缺损行吻合指掌侧固有神经的指动脉逆行岛皮瓣修复术。结果：（1）指掌侧固有神经平近节指横纹处理1．4－2．0mm，厚0．8－1．0mm；平末节指横纹处宽1．0－1．4mm，厚0．6－0．8mm。（2）近节掌侧支为4．4－5．3支，背侧支为3．8－4．0支；中节掌侧支为3．5－4．6支，背侧支为3．4－4．1支；末节终支为3．8－4．6支。（3）39例患指中38例一期成活，指腹饱满，外观理想，耐磨性好，两点辨别觉达5mm内，指腹感觉达S3以上。结论：吻合指神经的指动脉逆行岛状皮瓣修复指腹缺损，优于未吻合神经的术式。

Applied anatomy of reversed digital artery island flap anastomosed with digital nerve for the repair of pulp defect

Objective: To study the anatomical basis and clinical application of the reversed digital artery island flap anastomosed with digital nerve for the repair of pulp defect. Methods: The diameters of the proper palmar digital nerves and dieir branches were measured on 40 hand specimens of 20 cadavers. Pulp defects were repaired with reversed digital artery island flaps anastomosed with digital nerve on 39 patients. Results: (l) Proper palmar digital nerves were 1.4-2.0 mm wide and 0.8 - 1.0 mm thick in the proximal end; 1.0-1.4 mm wide and 0.6-0.8 mm thick in the distal end. (2) There were 4.4- 5.3 palmar branches and 3.8 - 5.0 dorsal branches in the proximal phalanx; 3.5 -4.6 palmar branches and 3.4-4.1 dorsal branches in the middle phalanx; There were 3.8-4.6 terminal branches in the distal phalanx. (3) Among 39 cases of pulp defects, 38 cases were healed after primary repair with good appearance and duration. The sense discrimination of two - point reached 5 mm, and the sense of pulp came up to S3. Conclusion: The operation with anastomosed nerves have got better results than that without anastomosed nerves.