手部带蒂皮瓣修复手指皮肤软组织缺损

摘要

Objective To report the surgical techniques and clinical result of pedicled hand flaps for reconstruction of finger soft tissue defects. Methods From October 2011 to September 2014, 51 cases of 59 fingers soft tissue defects, among these 16 thumb fingers, 19 index fingers, 13 middle fingers, 7 ring fingers and 4 little fingers were involved. V-Y advancement flaps were used in 20 fingers, dorsal digital flaps from the index were used in 3 fingers, reversed dorsal metacarpal flaps were used in 13 fingers, radius-dorsal digital flaps from the thumb were used in 8 fingers, reversed digital artery flaps were used in 15 fingers. Results 58 of the 59 flaps in 51 patients survived. One flap had partial necrosis and the wound closed after change dressings many times. 59 patients were followed-up for 7 to 36 months (mean, 13 months). No patient was lost to follow-up. The flaps were supple and full. Two-point discrimination was 3 to 10 mm with an average of 6.1 mm. There were no bulkiness and tenderness. The postoperative outcomes were evaluated by the total active movement (TAM) scale. The results were rated as excellent in 51 fingers, good in 6 fingers and fair in 2 fingers. The overall satisfactory rate was 96.6%. Conclusion It is a good satisfactory way and option for reconstruction of finger soft tissue defects by pedicled flap of hand.%目的 探讨多种手部带蒂皮瓣修复手指皮肤软组织缺损的手术方法和临床疗效.方法 2011年10月-2014年9月,收治手指皮肤软组织缺损51例59指,其中拇指16指,示指19指,中指13指,环指7指,小指4指.分别采用"V-Y"推进皮瓣修复20指,示指背侧皮瓣修复3指,掌背逆行皮瓣修复13指,第1掌骨桡背侧皮瓣修复8指,指动脉逆行皮瓣修复15指.结果 本组51例59指皮瓣中58指皮瓣完全成活;1例皮瓣部分坏死,经换药后愈合.术后均获得7~36个月的随访,平均13个月.皮瓣质地柔软,外观饱满,两点辨别觉为3.0~10.0 mm,平均6.1 mm,无外观臃肿、触痛等并发症.手功能按手指总主动活动度(TAM)法评定:优51指,良6指,可2指,优良率96.6%.结论 手部带蒂皮瓣是修复手指皮肤软组织缺损的一种良好方法.