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

摘要

目的 分析并比较带神经的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的效果.方法 2014年1月至2015年6月将43例(50指)指端缺损的急诊手术患者采用抽签法随机分为2组,分别采用带神经的指动脉逆行岛状皮瓣(23例27指)与指动脉背侧支岛状皮瓣(20例23指)进行修复.比较2组术式的手术时间、患者对患指外观的满意度、皮瓣静态两点辨距觉、患指活动度及供区术后外观等情况.结果 术后2组皮瓣全部成活.随访时间12～18个月.2组患者手术时间及术后患指活动度方面差异无统计学意义(P＞0.05).而患者对患指外观满意度及皮瓣静态两点辨距觉比较时,指动脉逆行岛状皮瓣组优于指动脉背侧支岛状皮瓣组,差异具有统计学意义(P＜0.05).术后供区外观比较时,指动脉逆行岛状皮瓣组供区植皮质地较柔软,无明显瘢痕挛缩及色素沉着,位置较隐蔽;指动脉背侧支岛状皮瓣组供区植皮位置较暴露,其中5例出现轻度瘢痕挛缩,影响手指美观.结论 指动脉逆行岛状皮瓣与指动脉背侧支岛状皮瓣均操作简单,解剖恒定,适用于手指指端缺损的修复,但与指动脉背侧支岛状皮瓣相比,指动脉逆行岛状皮瓣能更好地重建指端感觉及外观.%Objective To compare the clinical effect of innervated reverse digital artery island flap and the digital artery island flap with dorsal branches in the repair of fingertip defects.Methods From January 2014 to June 2015,a total of 43 cases (50 fingers) with fingertip defects in 2-5 fingers were randomly treated with reverse digital artery island flaps (23 cases) or the digital artery island flaps with dorsal branches (20 cases).All cases underwent emergency surgery.The operative time,patient satisfaction of appearance for the reconstructed fingers,the static 2-point discrimination of the flaps,active motion of the injured finger joints and postoperative appearance on donor site were compared respectively.Results All flaps survived primarily.The follow-up period ranged from 12-18 months.No significant differences were found in operative time and active motion of the injured finger joints between the two groups (P ＞ 0.05).Patient satisfaction of appearance and the static 2-point discrimination of the flaps in reverse digital artery island flap group were better than those in the digital artery dorsal branch island flap group (P ＜ 0.05).For the donor site,the texture of donor site in reverse digital artery island flap was soft without significant Scar contracture and pigmentation.There were 5 cases with mild scar contracture in donor site at the digital artery island flap with dorsal branches.Conclusions The reverse digital artery island flap and the digital artery island flap with dorsal branches are all suitable for the repair of fingertip defects.Compared with the digital artery island flap with dorsal branch,the reverse digital artery island flap can provide better fingertip sense and appearance.