三种皮瓣修复手指皮肤缺损的疗效观察
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摘要
目的探讨三种不同部位皮瓣修复手指皮肤缺损的疗效。方法 2015年2月-2017年12月以63例手指皮肤缺损患者为研究对象,依据移植皮瓣不同分为指侧方皮支链皮瓣组21例(A组)、指背皮神经血管皮瓣组21例(B组)、邻指皮瓣组21例(C组),缺损范围1.1 cm×1.2 cm～1.4 cm×2.2 cm,对比三组术后皮肤缺损修复效果及术后12个月随访结果。结果三组皮瓣均成活;三组皮瓣手术时间均较短,差异无统计学意义(P>0.05);A组感觉功能好于B组,但差异无统计学意义(P>0.05),A组较C组差异有统计学意义(P <0.05),B组感觉功能恢复好于C组,差异显著(P <0.05);三组外形恢复、TAM(功能分级)评分、术后并发症差异无统计学意义(P>0.05)。结论三种不同部位皮瓣修复方法均操作较简单、外形恢复较好,但指侧方皮支链皮瓣感觉功能恢复更好。
Objective To investigate the effect of three different skin flaps on the repairing of finger skin defects. Methods Sixty-three patients with finger skin defect from February 2015 to December 2017 in our hospital were studied. According to the transplantation flaps, the patients were divided into fingerplate flap group of the lateral square skin branch with 21 cases(group A), digital dorsal cutaneous nerve vascular flap group with 21 cases(group B), and crossing flap group with 21 cases(group C). The defect range was1.1 cm × 1.0 cm to 1.4 cm × 2.2 cm. The effects of postoperative skin defect repair and 12 months' follow-up results of 3 groups were compared. Results All 3 groups of flaps survived. There was no significant difference in the operation time in all three groups(P >0.05); patients in group A had better sensory function, and were better than patients in group B, but the difference was not significant(P >0.05), the patient's sensory function of Group A recovered better than Group C, with significant differences(P <0.05); group B had better sensory function than patients in group C, with significant differences(P <0.05). There were no significant differences in appearance recovery, TAM score and postoperative complications in 3 groups(P >0.05). Conclusion All three methods of skin injury repair are simple and good in shape, but the flap with lateral digital cutaneous branch chain has better sensory recovery and is suitable for clinical application.
Objective To investigate the effect of three different skin flaps on the repairing of finger skin defects. Methods Sixty-three patients with finger skin defect from February 2015 to December 2017 in our hospital were studied. According to the transplantation flaps, the patients were divided into fingerplate flap group of the lateral square skin branch with 21 cases(group A), digital dorsal cutaneous nerve vascular flap group with 21 cases(group B), and crossing flap group with 21 cases(group C). The defect range was1.1 cm × 1.0 cm to 1.4 cm × 2.2 cm. The effects of postoperative skin defect repair and 12 months' follow-up results of 3 groups were compared. Results All 3 groups of flaps survived. There was no significant difference in the operation time in all three groups(P >0.05); patients in group A had better sensory function, and were better than patients in group B, but the difference was not significant(P >0.05), the patient's sensory function of Group A recovered better than Group C, with significant differences(P <0.05); group B had better sensory function than patients in group C, with significant differences(P <0.05). There were no significant differences in appearance recovery, TAM score and postoperative complications in 3 groups(P >0.05). Conclusion All three methods of skin injury repair are simple and good in shape, but the flap with lateral digital cutaneous branch chain has better sensory recovery and is suitable for clinical application.
引文
[1]吴波,廖苏平,危蕾,等.手指侧方皮支血管链皮瓣和指动脉岛状皮瓣修复指端缺损的疗效比较[J].中华手外科杂志,2016,32(6):464-465.
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[6]郑晓东,黄辉强,陈锦涛,等.指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损60例[J].中华显微外科杂志,2016,39(4):333-336.
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[10]黄辉强,郑晓东,张敬良,等.微型动脉化静脉皮瓣修复50例指端皮肤缺损[J].中华显微外科杂志,2016,39(2):188-191.
[11]阳跃,崔树森,李春雨,等.重建感觉的游离臂外侧皮瓣修复手背皮肤缺损12例疗效分析[J].中华显微外科杂志,2016,39(3):234-236.
[12]王辉,杨晓溪,王斌,等.带神经同指指动脉逆行岛状皮瓣与指动脉背侧支岛状皮瓣修复指端缺损效果比较[J].中华整形外科杂志,2017,33(4):263-266.
[13]Zhu L,Xu Q,Kou W,et al.Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects[J].Indian J Orthop,2014,48(6):594-598.
[14]Acar MA,Güle A,Aydin BK,et al.Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps[J].Eur J Orthop Surg Traumatol,2015,25(4):723-729.
[15]杨林,刘宏君,顾家祥,等.同指带指固有神经皮支指动脉逆行岛状皮瓣与邻指皮瓣修复指端软组织缺损的疗效比较[J].实用手外科杂志,2017,31(4):424-427.
[2]杨焕友,李颖,王斌,等.近节指掌侧固有动脉背侧支皮瓣修复小儿手指中节皮肤缺损[J].中华显微外科杂志,2016,39(4):330-333.
[3]王思月,王钦航,冯满林,等.带感觉神经的尺动脉近端穿支皮瓣修复手指掌侧皮肤缺损[J].中华手外科杂志,2016,32(3):233-234.
[4]冯铁成,黄永辉,刘方刚,等.跗外侧皮瓣与邻指皮瓣修复手指皮肤缺损的比较[J].中国矫形外科杂志,2017,25(12):1086-1090.
[5]杨焕友,李颖,王斌,等.两种改良指侧方岛状皮瓣修复拇指指腹缺损的疗效观察[J].中华烧伤杂志,2016,32(7):432-433.
[6]郑晓东,黄辉强,陈锦涛,等.指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损60例[J].中华显微外科杂志,2016,39(4):333-336.
[7]赵世波,于东利,徐晓梅,等.指动脉背侧终末支皮瓣修复指末端缺损[J].中华手外科杂志,2016,32(6):449-450.
[8]Yamamoto T,Yoshimatsu H,Kikuchi K,et al.Free prepuce perforator flap:Ultra-thin superficial penile artery perforator flap for a dorsal finger defect[J].Microsurgery,2017,37(3):252-255.
[9]Li KW,Song DJ,Liu J,et al.Tripaddle Posterior Interosseous Artery Flap Design for 3-Finger Defects:An Evaluation of 3 Surgical Approaches[J].Ann Plast Surg,2016,77(4):406-412.
[10]黄辉强,郑晓东,张敬良,等.微型动脉化静脉皮瓣修复50例指端皮肤缺损[J].中华显微外科杂志,2016,39(2):188-191.
[11]阳跃,崔树森,李春雨,等.重建感觉的游离臂外侧皮瓣修复手背皮肤缺损12例疗效分析[J].中华显微外科杂志,2016,39(3):234-236.
[12]王辉,杨晓溪,王斌,等.带神经同指指动脉逆行岛状皮瓣与指动脉背侧支岛状皮瓣修复指端缺损效果比较[J].中华整形外科杂志,2017,33(4):263-266.
[13]Zhu L,Xu Q,Kou W,et al.Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects[J].Indian J Orthop,2014,48(6):594-598.
[14]Acar MA,Güle A,Aydin BK,et al.Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps[J].Eur J Orthop Surg Traumatol,2015,25(4):723-729.
[15]杨林,刘宏君,顾家祥,等.同指带指固有神经皮支指动脉逆行岛状皮瓣与邻指皮瓣修复指端软组织缺损的疗效比较[J].实用手外科杂志,2017,31(4):424-427.