邻指皮瓣与同指背逆行岛状皮瓣修复指端缺损的临床分析
|
摘要
目的观察同指背逆行岛状皮瓣修复指端缺损,探讨其临床价值。方法选择2013年1月—2015年10月收治的单指指端缺损患者60例入选本研究,均符合手术指征且均无明显手术禁忌证,按照数字随机法分为2组,邻指皮瓣组30例32指采取邻指皮瓣手术治疗,根据指端缺损于邻指中节背侧设计皮瓣。同指背逆行岛状皮瓣组30例36指采取同指背逆行岛状皮瓣修复手术治疗,术者根据指端缺损大小于手指中节背侧设计皮瓣,侧缘不超过手指侧中线;并于皮瓣远侧缘设计三角形皮瓣。比较2组患者住院时间等一般情况及疗效。结果同指背逆行岛状皮瓣组手术时间为(41.5±12.3)min,与邻指皮瓣组(42.6±13.6)min比较差异无统计学意义(P>0.05);同指背逆行岛状皮瓣组住院时间为(7.3±0.8)d,显著短于邻指皮瓣组(10.8±1.2)d,差异具有统计学意义(P<0.05)。同指背逆行岛状皮瓣组皮瓣疗效优12例(40.0%),良17例(56.7%),可1例(3.3%),差0例(0.0%),优良率为96.7%(29/30),显著优于邻指皮瓣组优11例(36.7%),良12例(40.0%),可7例(23.3%),差0例(0.0%),优良率76.7%(23/30),χ~2=5.192,P<0.05,差异具有统计学意义。结论同指背逆行岛状皮瓣修复指端缺损疗效较佳,具有重要的临床价值,值得临床推广。
Objective To investigate the clinical value of same finger reverse island flap for repairing fingertip defects.Methods Sixty cases of fingertip defect in our hospital from January,2013 to October,2015 were selected. All cases conform to operation indication and have no obvious surgical contraindication. The patients were randomly divided into two groups. Thirty-two fingers of 30 cases in the adjacent finger skin flap group were taken the adjacent finger flap surgery treatment,in the dorsal of adjacent finger middle segment designed the flap according to fingertip defects area. Thirty-six fingers of 30 cases in the same finger reverse island flap group were taken the same finger dorsal island flap repair surgery treatment,in the dorsal of finger middle segment designed flap according to the defects area,the lateral margin less than side central line. The triangle flaps at distal margin were designed. The general condition and curative effect of the two groups were compared. Results The operation time of same finger reverse island flap group was( 41. 5 ± 12. 3) min,adjacent finger skin flap group was( 42. 6 ± 13. 6) min. There was no significant difference between the two groups,P >0. 05. The length of stay in the same finger reverse island flap group was( 7. 3 ± 0. 8) d,significantly shorter than that in the adjacent finger skin flap group( 10. 8 ± 1. 2) d,the difference was statistically significant,P < 0. 05. There were 12 cases( 40. 0%) superior,17 cases( 56. 7%) good,1 case( 3. 3%) fine and no inferior case in same finger reverse island flap group. There were 11 cases( 36. 7%) superior,12 cases( 40. 0%) good,7 case( 23. 3%) fine and no inferior case in adjacent finger skin flap group. The excellent rate of same finger reverse island flap group was 96. 7%,it was significantly better than adjacent finger skin flap group's 76. 7%,χ~2= 5. 192,P < 0. 05,the difference was statistically significant.Conclusion The method of reverse island flap of the same finger to repair fingertip defect has better curative effect and important clinical value,which is worth to be popularized.
Objective To investigate the clinical value of same finger reverse island flap for repairing fingertip defects.Methods Sixty cases of fingertip defect in our hospital from January,2013 to October,2015 were selected. All cases conform to operation indication and have no obvious surgical contraindication. The patients were randomly divided into two groups. Thirty-two fingers of 30 cases in the adjacent finger skin flap group were taken the adjacent finger flap surgery treatment,in the dorsal of adjacent finger middle segment designed the flap according to fingertip defects area. Thirty-six fingers of 30 cases in the same finger reverse island flap group were taken the same finger dorsal island flap repair surgery treatment,in the dorsal of finger middle segment designed flap according to the defects area,the lateral margin less than side central line. The triangle flaps at distal margin were designed. The general condition and curative effect of the two groups were compared. Results The operation time of same finger reverse island flap group was( 41. 5 ± 12. 3) min,adjacent finger skin flap group was( 42. 6 ± 13. 6) min. There was no significant difference between the two groups,P >0. 05. The length of stay in the same finger reverse island flap group was( 7. 3 ± 0. 8) d,significantly shorter than that in the adjacent finger skin flap group( 10. 8 ± 1. 2) d,the difference was statistically significant,P < 0. 05. There were 12 cases( 40. 0%) superior,17 cases( 56. 7%) good,1 case( 3. 3%) fine and no inferior case in same finger reverse island flap group. There were 11 cases( 36. 7%) superior,12 cases( 40. 0%) good,7 case( 23. 3%) fine and no inferior case in adjacent finger skin flap group. The excellent rate of same finger reverse island flap group was 96. 7%,it was significantly better than adjacent finger skin flap group's 76. 7%,χ~2= 5. 192,P < 0. 05,the difference was statistically significant.Conclusion The method of reverse island flap of the same finger to repair fingertip defect has better curative effect and important clinical value,which is worth to be popularized.
引文
[1]Chen W,Fan J,Liu L,et al.Upper and Lower Eyelid Full Thickness Reconstruction Using a Retrograde Postauricular Island Flap[J].J Pediatr Gastroenterol Nutr,2015,2(8):112-115.
[2]Shen XF,Xue MY,Mi JY,et al.Innervated Digital Artery Perforator Propeller Flap for Reconstruction of Lateral Oblique Fingertip Defects[J].J Hand Surg Am,2015,40(7):1382-1388.
[3]Fu S,Fan J,Chen W,et al.Aesthetic correction of severe cicatricial upper-eyelid ectropion with a retrograde postauricular island flap[J].Aesthetic Plast Surg,2013,37(1):95-101.
[4]Li YG,Chen XJ,Zhang YZ,et al.Three-dimensional digitalized virtual planning for retrograde sural neurovascular island flaps:a comparative study[J].Burns,2014,40(5):974-980.
[5]Chen QZ,Sun YC,Chen J,et al.Comparative study of functional and aesthetically outcomes of reverse digital artery and reverse dorsal homodigital island flaps for fingertip repair[J].J Hand Surg Eur Vol,2015,40(9):935-943.
[6]Mao H,Shi Z,Yin W,et al.Reconstruction of great toe soft-tissue defect with the retrograde-flow medial pedis island flap[J].Plast Reconstr Surg,2014,134(1):120-127.
[7]谢艾玲,张荐,卢爱东,等.逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤缺损[J].中国修复重建外科杂志,2014,28(12):1498-1501.
[8]Usami S,Kodaira S,Homma T,et al.Postoperative voluminal flap reduction after fingertip reconstruction using the reverse digital artery island flap[J].Hand Surg,2015,20(1):133-136.
[9]陈亚伟,曹能力,李伟,等.手部加长血管蒂皮瓣修复手指中节以远软组织缺损[J].医药论坛杂志,2014,35(4):349-352.
[10]黄俊.皮瓣在手指软组织缺损修复中的应用研究进展[J].安徽医学,2014,35(6):857-860.
[11]卢忠存,彭伟华,韦铭铭.指动脉终末背侧支逆行岛状皮瓣的解剖及临床应用(附20例报告)[J].广西医学,2012,34(12):1663-1665.
[12]Vergara-Amador E.The Retrograde Ulnar Dorsal Flap:Surgical Technique and Experience as Island Flap in Coverage of Hand Defects[J].Tech Hand Up Extrem Surg,2015,19(3):90-94.
[13]Zhao F,He W,Zhang G,et al.Comparison of Shoulder Management Strategies after Stage I of Fingertip Skin Defect Repair with a Random-Pattern Abdominal Skin Flap[J].Med Sci Monit,2015,21(9):3042-3047.
[14]Acar MA,Guzel Y,Gulec A,et al.Reconstruction of multiple fingertip injuries with reverse flow homodigital flap[J].Injury,2014,45(10):1569-1573.
[15]李剑强.静脉动脉化皮瓣游离移植修复四肢小创面的前瞻性临床研究[J].中国医学创新,2014,11(12):62-63.
[2]Shen XF,Xue MY,Mi JY,et al.Innervated Digital Artery Perforator Propeller Flap for Reconstruction of Lateral Oblique Fingertip Defects[J].J Hand Surg Am,2015,40(7):1382-1388.
[3]Fu S,Fan J,Chen W,et al.Aesthetic correction of severe cicatricial upper-eyelid ectropion with a retrograde postauricular island flap[J].Aesthetic Plast Surg,2013,37(1):95-101.
[4]Li YG,Chen XJ,Zhang YZ,et al.Three-dimensional digitalized virtual planning for retrograde sural neurovascular island flaps:a comparative study[J].Burns,2014,40(5):974-980.
[5]Chen QZ,Sun YC,Chen J,et al.Comparative study of functional and aesthetically outcomes of reverse digital artery and reverse dorsal homodigital island flaps for fingertip repair[J].J Hand Surg Eur Vol,2015,40(9):935-943.
[6]Mao H,Shi Z,Yin W,et al.Reconstruction of great toe soft-tissue defect with the retrograde-flow medial pedis island flap[J].Plast Reconstr Surg,2014,134(1):120-127.
[7]谢艾玲,张荐,卢爱东,等.逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤缺损[J].中国修复重建外科杂志,2014,28(12):1498-1501.
[8]Usami S,Kodaira S,Homma T,et al.Postoperative voluminal flap reduction after fingertip reconstruction using the reverse digital artery island flap[J].Hand Surg,2015,20(1):133-136.
[9]陈亚伟,曹能力,李伟,等.手部加长血管蒂皮瓣修复手指中节以远软组织缺损[J].医药论坛杂志,2014,35(4):349-352.
[10]黄俊.皮瓣在手指软组织缺损修复中的应用研究进展[J].安徽医学,2014,35(6):857-860.
[11]卢忠存,彭伟华,韦铭铭.指动脉终末背侧支逆行岛状皮瓣的解剖及临床应用(附20例报告)[J].广西医学,2012,34(12):1663-1665.
[12]Vergara-Amador E.The Retrograde Ulnar Dorsal Flap:Surgical Technique and Experience as Island Flap in Coverage of Hand Defects[J].Tech Hand Up Extrem Surg,2015,19(3):90-94.
[13]Zhao F,He W,Zhang G,et al.Comparison of Shoulder Management Strategies after Stage I of Fingertip Skin Defect Repair with a Random-Pattern Abdominal Skin Flap[J].Med Sci Monit,2015,21(9):3042-3047.
[14]Acar MA,Guzel Y,Gulec A,et al.Reconstruction of multiple fingertip injuries with reverse flow homodigital flap[J].Injury,2014,45(10):1569-1573.
[15]李剑强.静脉动脉化皮瓣游离移植修复四肢小创面的前瞻性临床研究[J].中国医学创新,2014,11(12):62-63.