手部皮神经营养血管皮瓣修复手指软组织缺损

摘要

Objective To investigate the surgical procedure of neurocutaneous flap transfer for covering digital defects, and to evaluate the treatment outcomes. Methods From March 2013 to March 2015, 22 cases with digital defects were treated by neurocutaneous flap, and assisted hand function execises since primary surgical procedures. Results In the 22 cases, swelling and gore occurred in 5 cases, which were remedied by removing stitches. Distal marginal flap necrosis occurred in 1 case, which healed by debridement. The others survived uneventfully. These cases were followed-up for 6 to 18 months posroperatively, 13.5 months on average. There was no bulkiness of the flap. All flaps got good texture. Two-point discrimination of the flap was 5 to 8 mm, 6.8 mm on average. Hand function recovered well. Both donor and harvested area had color match and no obvious scar contracture. According to the Total Active Movement standard:The results were execellent in 14 cases, good in 5 cases, and fair in 3 cases, the good grade rate was 86.4%. Conclusion Transfer of neurocutaneous flap for repairing digital defects is a simple surgery, no majior artery needs to be sacrificed, and repair of wound in one stage. It is an effective method for repairing digital defects,that is worthy wide clinical application.%目的：探讨手部皮神经营养血管皮瓣修复手指软组织缺损的手术方法和临床疗效。方法2013年3月-2015年3月，采用手部皮神经营养血管皮瓣转移修复手指软组织缺损22例，并辅助早期功能锻炼。结果22例皮瓣中，5例术后出现皮瓣肿胀、瘀血，经拆线减压后缓解；1例皮瓣出现远端坏死，经换药后愈合；其余皮瓣均顺利成活。随访6～18个月，平均13.5个月，皮瓣外形无明显臃肿，质地与周围组织接近，两点辨别觉为5～8 mm，平均6.8 mm；手功能恢复满意，供受区无明显瘢痕挛缩或色素沉着。按手指总主动活动度评定法评定：优14指，良5指，可3指，优良率86.4%。结论采用手部皮神经营养血管皮瓣修复手指软组织缺损，供受区皮肤质地、色泽相近，手术方法简单，不损伤手部主要血管，且一次完成，是修复手部软组织缺损切实可行的术式之一，值得推广。