携带神经的示指桡侧指背动脉逆行岛状皮瓣重建示指外形及感觉
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摘要
目的探讨携带神经的示指桡侧指背动脉逆行岛状皮瓣重建手指外形及感觉的临床效果。方法选取2015年1月-2018年5月收治的54例示指皮肤软组织缺损患者的临床资料,其中采用携带神经的示指桡侧指背动脉逆行岛状皮瓣修复(A组),随意腹部皮瓣修复(B组),及采用手外伤"V-Y"推进皮瓣修复(C组)各18例。对入选患者进行随访,对术后指腹综合质地感觉、手指总主动活动度(TAM)、皮肤感觉恢复情况、皮瓣两点辨别觉(2 PD)等指标进行比较。结果术后54例皮瓣全部成活,A组修复后在皮肤色泽、质地、外形上较为满意,指腹综合质地感觉优于B、C两组(P <0.05);在皮瓣感觉恢复、TAM、2 PD等指标上,A组均好于B、C两组,差异有统计学意义(P <0.05)。结论携带神经的示指桡侧指背动脉逆行岛状皮瓣修复示指皮肤软组织缺损在综合质地感觉、感觉恢复情况、两点辨别觉等方面具有优势,是较为理想的修复术式。
Objective To investigate the effect of reconstruction of shape and sensation of index finger with retrograde island flap of radial dorsal digital artery with nerve. Methods The clinical data of 54 patients with soft tissue defect admitted to our hospital from January 2015 to May 2018 was collected.Among them, 18 cases were repaired with radial dorsal digital artery retrograde island flap(group A), 18 cases with random abdominal flap(group B) and 18 cases with hand trauma "V-Y" advanced flap(group C). The selected patients were followed up after surgery, and the comprehensive texture sensation of finger pulp, total active motion of fingers(TAM), skin sensory recovery, two-point discrimination of skin flap(2PD) were compared. Results In group A, the skin color, texture and appearance were satisfactory;and the comprehensive texture sensation of pulp, the sensory recovery of skin flap, TAM and 2PD were better than those in group B and C(P <0.05). Conclusion The reconstruction of shape and sensation of index finger with soft tissue defect of radial dorsal digital artery has advantages in comprehensive texture sensation, sensory recovery and two-point discrimination. It is an ideal method to repair index finger soft tissue defect.
Objective To investigate the effect of reconstruction of shape and sensation of index finger with retrograde island flap of radial dorsal digital artery with nerve. Methods The clinical data of 54 patients with soft tissue defect admitted to our hospital from January 2015 to May 2018 was collected.Among them, 18 cases were repaired with radial dorsal digital artery retrograde island flap(group A), 18 cases with random abdominal flap(group B) and 18 cases with hand trauma "V-Y" advanced flap(group C). The selected patients were followed up after surgery, and the comprehensive texture sensation of finger pulp, total active motion of fingers(TAM), skin sensory recovery, two-point discrimination of skin flap(2PD) were compared. Results In group A, the skin color, texture and appearance were satisfactory;and the comprehensive texture sensation of pulp, the sensory recovery of skin flap, TAM and 2PD were better than those in group B and C(P <0.05). Conclusion The reconstruction of shape and sensation of index finger with soft tissue defect of radial dorsal digital artery has advantages in comprehensive texture sensation, sensory recovery and two-point discrimination. It is an ideal method to repair index finger soft tissue defect.
引文
[1]赵军,朱爱剑,曾昕明,等.游离移植定点法改良甲皮瓣在拇指再造及拇指脱套伤中的应用[J].实用手外科杂志,2016,30(4):432-435.
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[13]郝睿峥,孟钊,杨焕友,等.同指指动脉背侧支皮瓣与邻指岛状皮瓣瓦合修复手指末节套脱伤[J].中华手外科杂志,2017,33(6):401-403.
[14]裴世杰,刘飙,张君,等.游离皮瓣在手部皮肤缺损修复中的选择及应用[J].实用手外科杂志,2017,31(2):240-245.
[15]梁好,陈莹恩,黎丹东,等.携带指固有神经直接小分支的指动脉逆行岛状皮瓣修复指端缺损[J].中华手外科杂志,2018,34(2):147-148.
[16]苗平,张秀秀,王瑞,等.腓动脉穿支皮瓣在手部皮肤软组织缺损中的应用[J].实用手外科杂志,2017,31(2):171-173.
[17]孙义元,王静成,刘宏君,等.应用游离趾腓侧皮瓣再造指腹15例[J].实用手外科杂志,2018,32(1):20-21.
[18]尹成国,郝作斌,高广辉,等.密闭包扎法与指动脉岛状皮瓣治疗指端缺损的临床疗效比较[J].实用手外科杂志,2017,31(2):157-159.
[2]梁高峰,郭永明,滕云升,等.改良短蒂双供血跗外侧皮瓣修复手指软组织缺损[J].实用手外科杂志,2016,30(4):450-452.
[3]杨海洲,顾家平,许勇.中节指背逆行筋膜蒂岛状皮瓣修复同指皮肤软组织缺损[J].中华手外科杂志,2017,33(3):220-221.
[4]刘兴邦,王运涛,陶圣祥.内踝上皮瓣在足跟部软组织缺损修复中的应用[J].实用手外科杂志,2017,31(2):169-170.
[5]余业文,王夫平,冷树立,等.邻指指动脉关节支皮瓣的临床研究[J].实用手外科杂志,2017,31(2):160-162.
[6]王澍寰.指端植皮的选择与晚期疗效[J].中华手外科杂志,1993,9(2):67-69.
[7]江吉勇,黄东,李培,等.游离桡动脉穿支皮瓣移植修复手指皮肤软组织缺损[J].实用手外科杂志,2018,32(1):13-16.
[8]余纯斌,江吉勇,李培,等.带掌长肌腱动脉化静脉皮瓣在修复手指背侧复合组织缺损中的应用[J].实用手外科杂志,2018,32(1):22-25.
[9]孙长胜,苏波,李文君,等.接合神经的拇指背侧皮瓣修复拇指再植坏死后创面的临床疗效[J].实用手外科杂志,2018,32(1):3-5.
[10]吴兴,阚世廉,张植生,等.拇指桡侧指动脉逆行岛状皮瓣修复拇指末节皮肤或(和)甲床小面积缺损[J].中华手外科杂志,2016,32(6):433-434.
[11]何如祥,雷林革,师富贵,等.游离皮瓣桥式交叉修复小腿复杂性创面[J].实用手外科杂志,2018,32(1):96-97.
[12]杨国栋,卢勇民,赵辉.应用改良第1掌骨桡背侧穿支皮瓣治疗拇指残端缺损[J].实用手外科杂志,2018,32(1):98-100.
[13]郝睿峥,孟钊,杨焕友,等.同指指动脉背侧支皮瓣与邻指岛状皮瓣瓦合修复手指末节套脱伤[J].中华手外科杂志,2017,33(6):401-403.
[14]裴世杰,刘飙,张君,等.游离皮瓣在手部皮肤缺损修复中的选择及应用[J].实用手外科杂志,2017,31(2):240-245.
[15]梁好,陈莹恩,黎丹东,等.携带指固有神经直接小分支的指动脉逆行岛状皮瓣修复指端缺损[J].中华手外科杂志,2018,34(2):147-148.
[16]苗平,张秀秀,王瑞,等.腓动脉穿支皮瓣在手部皮肤软组织缺损中的应用[J].实用手外科杂志,2017,31(2):171-173.
[17]孙义元,王静成,刘宏君,等.应用游离趾腓侧皮瓣再造指腹15例[J].实用手外科杂志,2018,32(1):20-21.
[18]尹成国,郝作斌,高广辉,等.密闭包扎法与指动脉岛状皮瓣治疗指端缺损的临床疗效比较[J].实用手外科杂志,2017,31(2):157-159.