摘要
目的:观察示指桡侧指背动脉逆行岛状皮瓣移植对示指指端缺损的修复效果。方法:选择2002-08/2005-09南华大学附属第一医院急诊收治的外伤性示指末节部分缺损患者13例,手术方法的选择在术前均得到患者同意,且得到医院伦理道德委员会批准。组织缺损大小在1.5cm×1.0cm～2.0cm×1.5cm之间,所有缺损均有指骨和(或)大部分的指腹组织缺损,采用示指桡侧指背动脉逆行岛状皮瓣移植修复,皮瓣设计:旋转点位于近侧指间关节的近端,皮瓣轴为示指的桡背侧,皮瓣部分设计在第2掌指关节的近侧,蒂宽约0.8mm。术后定期随访,主要观察皮瓣质地和感觉的恢复情况,将感觉恢复的评估标准分为5级:S1:无感觉;S5:在神经单一分布区恢复两点鉴别能力。结果:13例患者全部进入结果分析,无脱落。①术后随访三四个月者10例,随访五六个月者3例。②术后9例皮瓣完全成活;4例皮瓣远端部分坏死,经换药表皮爬行创面愈合。③外形基本满意,皮瓣色泽、质地良好。④术后1个月随访时,3例患者两点辨别觉大于6.0mm,感觉恢复S4;术后五六个月随访时,3例患者两点辨别觉4.0～6.0mm,感觉恢复S5。结论:示指桡侧指背动脉逆行岛状皮瓣设计的旋转点位于近侧指间关节的近端,可以简化手术而不影响皮瓣存活,是示指部分缺损修复的可选方法。
AIM： To investigate reverse-flow island flap transplantation of radialis dorsal digital artery for index fingertip METHODS： A total of 13 patients with partly loss of distal interphalangeal joint in index finger, were recruited from the Department of Outpatients, the First Affiliated Hospital of Nanhua University from August 2002 to September 2005. The experiment was approved by the Medical Ethnic Committee and permitted by all the patients. Defect sizes were ranged from 1.5 cm×l.0 cm to 2.0 cm ×l.5 cm, and all index fingers injuries of finger bone and pulp were covered with reverse-flow island flap transplantation of radialis dorsal digital artery. With the turn-over point at the level of proximal to proximal interdigital joint, the flap was elevated at the dorsum of index finger, proximal to metacarpal-phalanx joint. Pedicles were dissected at 0.8 mm wide. All the patients were followed up to observe the flap texture and sensory recovery, which was graded as five ranks： S1： insensible; S5： recovery of the two-point discrimination in the areas which mono nerve cells distributed. RESULTS： Thirteen patients were all involved in the result analysis.①Postoperative follow-up was lasted for 34 months in 7 patients and 5-6 months in 3 patients.②Nine flaps healed uneventfully, other 4 patients occurred partial necrosis of the flap and healed by drug changes.③Flap color and texture were good and the shape was satisfying.④Dudng the one month of follow-up, the two-point discrimination of 3 cases were over 6.0 mm, with S4 sensory recovery; During 5-6 months of follow-up, the two-point discrimination of 3 cases were ranged 4.0-6.0 mm, with S5 sensory recovery. CONCLUSION： Reverse-flow island flap for radialis dorsal digital artery is proximal to the proximal interdigital joint, and it can simplify the operation and have no effect on flap survival. It is a good alternative for reconstruction of index fingertip injuries.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第29期5668-5671,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
作者简介
谢红炬，男．1968年生，湖南省祁阳县人，汉族，1990年南华大学毕业，硕士，副主任医师，副教授，主要从事皮瓣方面的研究。yzj_0429@yahoo.com.cn
