CAJ | 학술논문

目的分析两种手指逆行岛状皮瓣修复指远节软组织缺损的临床效果的异同、适应证和注意事项. 方法从2000年1月至2008年7月,共收治500例514指远节软组织缺损,按照缺损面积分别采用同指侧方逆行岛状皮瓣(250例263指)和邻指侧方逆行岛状皮瓣(250例251指)修复.术后随访3～8年,比较两种皮瓣的修复范围、指蹼开大角度、皮瓣感觉等. 结果 500例514指皮瓣全部成活,术后随访按照皮瓣修复范围比较,邻指皮瓣(2.5 cm×5.0 cm)优于同指皮瓣(2.0 cm× 3.0 cm)(P＜0.05)；按照指蹼开大角度(大于或等于30°)比较,同指皮瓣(229指)优于邻指皮瓣(166指)(P＜0.05)；同指皮瓣的感觉恢复略好于邻指皮瓣(P＜0.05)；按照远期效果比较,两者差异无统计学意义(P＞0.05). 结论在手指远节小于2.0 cm× 2.5 cm软组织缺损,可选用同指皮瓣；超过2.0 cm×3.0cm软组织缺损,应选用邻指皮瓣.依据皮瓣修复面积首选邻指皮瓣；依据指蹼开大和感觉恢复首选同指皮瓣；依据手指灵活性,两种皮瓣均可.
목적 분석량충수지역행도상피판수복지원절연조직결손적림상효과적이동、괄응증화주의사항. 방법 종2000년1월지2008년7월,공수치500례514지원절연조직결손,안조결손면적분별채용동지측방역행도상피판(250례263지)화린지측방역행도상피판(250례251지)수복.술후수방3～8년,비교량충피판적수복범위、지복개대각도、피판감각등. 결과 500례514지피판전부성활,술후수방안조피판수복범위비교,린지피판(2.5 cm×5.0 cm)우우동지피판(2.0 cm× 3.0 cm)(P＜0.05)；안조지복개대각도(대우혹등우30°)비교,동지피판(229지)우우린지피판(166지)(P＜0.05)；동지피판적감각회복략호우린지피판(P＜0.05)；안조원기효과비교,량자차이무통계학의의(P＞0.05). 결론 재수지원절소우2.0 cm× 2.5 cm연조직결손,가선용동지피판；초과2.0 cm×3.0cm연조직결손,응선용린지피판.의거피판수복면적수선린지피판；의거지복개대화감각회복수선동지피판；의거수지령활성,량충피판균가.
Objective To analysis the clinic outcome (similarities & differences, indication and caution) of repairing fingertip soft tissue defect with two kind of reverse digital artery island flaps with the palmar cutaneous branch of proper digital nerve. Methods From January 2000 to Auguest 2008, all 500cases (514 fingers) were repaired with reverse homodigital artery island flap (263 fingers of 250 cases) and reverse cross finger digital artery island flap(251 fingers of 250 cases).All cases were followed up from 3-8years,compared with flap range,finger extension,sensory rehabilitation,et al. Results All flaps (A & Bgroup) of 500 cases (514 fingers) survived.According to flap range,cross finger flap was better than homodigital flap (P ＜ 0.05); according to finger extension,homodigital flap better than cross finger flap (P ＜0.05); according to sensory rehabilitation,homodigital flap little better than cross finger flap(P ＜ 0.05); according to long-term follow-up, all had no obviously different (P ＞ 0.05). Conclusion Homodigital flap can cover distal soft tissue defect less than 2.0 cm× 2.5 cm, cross finger flap is a better choice for more than 2.0cm×3.0cm of distal soft tissue defect. According to the flap cover area, cross finger flap is first choice,and to finger extension & sensory rehabilitation,homodigital flap is first choice; accoding to finger movements,two kinds of flaps are all good choice.