【摘要】 目的探讨带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损的临床效果。方法总结2011年6月至2014年6月期间,采用带指掌侧固有动脉或其分支局部顺行皮瓣转移修复的83例118个指端缺损的临床资料。结果 92个皮瓣顺利成活。7个背侧旋转皮瓣、5个V-Y推进皮瓣在术后24 h内出现动脉危象,9个背侧旋转皮瓣、5个掌侧旋转皮瓣在术后24 h内出现静脉危象。视循环危象具体情况分别采用拆除皮瓣周边、蒂部部分缝线,皮瓣小切口放血,皮瓣按摩,改变手指体位,患指制动等方法处理。动脉危象皮瓣4个存活,8个部分坏死。静脉危象皮瓣8个存活,6个部分坏死。皮瓣供区植皮57/62例(91.9%)全部成活。67例99指获得3~12个月、平均5.5个月的随访。皮瓣色泽红润、质地柔软、外观自然、不臃肿,与周围皮肤接近。皮瓣蒂部不臃肿。指端饱满,外形良好。两点辨别觉8~12 mm,无痛性瘢痕形成,无严重触痛。患指各关节活动基本正常,无关节坚硬。患者能适应正常工作与生活,对指端感觉及伤指外形均较满意。按中华医学会手外科学会上肢部分功能评定试用标准评定,优63指,良20指,可16指,优良率83.8%。结论带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损,方法简便,无需复杂显微外科技术,效果满意,对供区影响小,成功率高,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the clinical outcomes of repairing fingertip defects by transferring topographical anterograde flaps pedicled with digital artery trunk or branch. Methods From Jun. 2011 to Jun. 2014, 118 fingers in 83 cases with fingertip defects were treated with topographical anterograde flaps pedicled with digital artery trunk or branch. We recorded and generalized the clinical materials. Results 92 flaps survived uneventfully. 7 digital artery dorsal branch flaps and 5 digital artery V-Y flaps occurred arterial crisis, 9 digital artery dorsal branch flaps and 5 digital artery volar branch flaps occurred venous crisis within 24 hours of the surgery. Based on the reasons which caused cyclic crisis, such as removing some stitches around and/or in the pedicle of the flap, small incision bleeding, flap massage, changing finger position, braking and so on were used. 4 flaps survived and 8 partial necrosis occurred due to arterial crisis. 8 flaps survived and 6 partial necrosis occurred because of venous crisis. There were 57 in 62 fingers(91.9%) with skin grafts at the donor sites survived completely. 99 fingers in 67 cases were followed-up from 3 to 12 months, average 5.5 months. The color, texture and contour of the flaps were good. There were no bulkiness, no painful scar, no tenderness and no ankylosis. Tow-point discrimination was 8 to 12 mm. Joint movement of the fingers were normal. The patients could adapt to normal work and life. They were satisfied with the exterior and the sensation of the fingertip post-operatively. Based on the upper limb functional assessment criteria issued by the Chinese Medical Association Hand Surgery Society, the results were rated as excellent in 63 fingers, good in 20 finger and fair in 16 finger. The overall satisfactory rate was 83.8%. Conclusion Repairing of fingertip defect with topographical anterograde flap pedicled with digital artery trunk or branch, the surgery operation is simple and safe, does not need complex microsurgical technique. It does little harm to the donor. That is to say, it is an effective, scientific and reliable method worthy of clinical application.更多还原