CAJ | 학술논문

目的探讨改良第一掌背动脉岛状皮瓣修复拇指远端软组织缺损的成活优良率和感觉重建的疗效.方法 2004年3月至2007年10月,应用第一掌背动脉(the first dorsal metacarpal artery,FDMCA)皮瓣修复拇指近(末)节掌侧软组织缺损65例,获得完整随访资料者49例.男37例,女12例;年龄18～65岁,平均32岁.分别采用改良(31例)及常规筋膜蒂切取法(18例)治疗.改良方法与传统方法不同之处在于蒂部除包含FDMCA及该血管周围1 mm的肌袖外,还携带第一背侧骨间肌两肌腹间沟内的组织及宽1.5～2.0 cm的深筋膜及骨间肌肌膜为蒂.并将筋膜蒂中的神经束切断与拇指掌侧指神经残端以8-0线吻合.对两组皮瓣出现远端坏死、血管危象的频率及感觉恢复的差异进行统计学分析.结果术后随访20个月～3年,平均2年.49块皮瓣中46块完全成活.用常规方法切取的皮瓣18例中5例术后出现血管危象,最终3块皮瓣远端部分坏死.31例改良FDMCA皮瓣成活良好,感觉恢复满意,且定位于拇指;18例神经转位皮瓣均有不同程度的混合感觉(33%)或异位感觉(62%),仅1例皮瓣感觉完全定位于拇指.结论改良筋膜蒂切取法的FDMCA皮瓣成活优良率明显提高.将皮瓣内携带的桡神经浅支与受区拇指掌侧指神经吻合可使皮瓣感觉定位于拇指,但尚不能证明其对皮瓣两点分辨觉及实体感觉恢复有明显影响.
목적 탐토개량제일장배동맥도상피판수복무지원단연조직결손적성활우량솔화감각중건적료효.방법 2004년3월지2007년10월,응용제일장배동맥(the first dorsal metacarpal artery,FDMCA)피판수복무지근(말)절장측연조직결손65례,획득완정수방자료자49례.남37례,녀12례;년령18～65세,평균32세.분별채용개량(31례)급상규근막체절취법(18례)치료.개량방법여전통방법불동지처재우체부제포함FDMCA급해혈관주위1 mm적기수외,환휴대제일배측골간기량기복간구내적조직급관1.5～2.0 cm적심근막급골간기기막위체.병장근막체중적신경속절단여무지장측지신경잔단이8-0선문합.대량조피판출현원단배사、혈관위상적빈솔급감각회복적차이진행통계학분석.결과 술후수방20개월～3년,평균2년.49괴피판중46괴완전성활.용상규방법절취적피판18례중5례술후출현혈관위상,최종3괴피판원단부분배사.31례개량FDMCA피판성활량호,감각회복만의,차정위우무지;18례신경전위피판균유불동정도적혼합감각(33%)혹이위감각(62%),부1례피판감각완전정위우무지.결론 개량근막체절취법적FDMCA피판성활우량솔명현제고.장피판내휴대적뇨신경천지여수구무지장측지신경문합가사피판감각정위우무지,단상불능증명기대피판량점분변각급실체감각회복유명현영향.
Objective To explore the survival rate and early-term effects of sensory reconstruction of the modified first dorsal metacarpal artery (FDMCA) flap in treatment of thumb distal soft tissue defect.Methods From March 2004 to October 2007, 65 patients with soft tissue defects of the thumb underwent the FDMCA flap in our department. Forty-nine cases with complete data were included in the study. There were 37 males and 12 females, with an average age of 32 years (ranged, 18-65 years). The conventional surgical methods were used in 18 cases while the improved surgical methods were in 31 cases. The distal necrosis, the vascular crisis rate and the sensory recovery were recorded. Results The mean follow-up period was 2 years (ranged, 20 months to 3 years). Forty-six flaps survived completely. Vascular crisis occurred in five cases harvested by the conventional methods. Eventually, three of them had a partial distal necrosis.Improved FDMCA flap survived well in all 31 patients. Flaps in these patients with nerve anastomosis restored satisfied sense and all sense were located in the thumb. Eighteen cases of nerve transfer group had different levels of mixed feelings (33%) or ectopic sensory (62%). Sense was located in the thumb completely in 1 case. Conclusion The modified FDMCA flap significantly increased the survival rate. Neurorrhaphy could make the sense of the flap locate in the thumb; however it had not been proved that its impact on the recovery of two-point discrimination and stereognosis.