CAJ | 학술논문

目的探讨拇指桡侧指固有动脉指背穿支皮瓣修复拇指同侧Ⅰ、Ⅱ度指端桡侧斜向缺损的临床应用及疗效. 方法选择2009年10月-2013年10月拇指Ⅰ、Ⅱ度指端斜行缺损患者12例,其中男6例,女6例;年龄10～40岁,平均30岁.致伤原因:机器切割伤4例,机器绞伤3例,锐器切割伤3例,重物压伤2例.Ⅰ度缺损6例,Ⅱ度缺损6例,创面均为斜向缺损,桡侧组织较尺侧缺损多.均采用拇指桡侧指固有动脉指背穿支皮瓣修复创面,皮瓣切取1 cm×2 cm～1.5cm×2.5cm,供瓣区植皮修复.观察创面愈合情况、皮瓣色泽、肿胀程度;检测皮瓣温度.按中华医学会手外科学会上肢部分功能评定试用标准评定手指功能. 结果术后皮瓣均成活,指端有保护性感觉,创面均Ⅰ期愈合;皮瓣色泽红润,基本接近正常皮肤组织,质地良好;皮瓣温度接近正常皮肤温度;皮瓣早期有轻度肿胀,1周左右消退.患者均获随访1～36个月,平均20个月;末次随访时皮瓣两点辨别觉为9～11 mm,平均10 mm.2例远侧指间关节僵硬,经康复锻炼后恢复正常功能.评定手指功能:优10例,良2例. 结论拇指桡侧指固有动脉指背穿支皮瓣修复同侧拇指Ⅰ、Ⅱ度桡侧指端斜行缺损疗效可靠,可最大限度保留手指长度及其功能.
목적 탐토무지뇨측지고유동맥지배천지피판수복무지동측Ⅰ、Ⅱ도지단뇨측사향결손적림상응용급료효. 방법 선택2009년10월-2013년10월무지Ⅰ、Ⅱ도지단사행결손환자12례,기중남6례,녀6례;년령10～40세,평균30세.치상원인:궤기절할상4례,궤기교상3례,예기절할상3례,중물압상2례.Ⅰ도결손6례,Ⅱ도결손6례,창면균위사향결손,뇨측조직교척측결손다.균채용무지뇨측지고유동맥지배천지피판수복창면,피판절취1 cm×2 cm～1.5cm×2.5cm,공판구식피수복.관찰창면유합정황、피판색택、종창정도;검측피판온도.안중화의학회수외과학회상지부분공능평정시용표준평정수지공능. 결과 술후피판균성활,지단유보호성감각,창면균Ⅰ기유합;피판색택홍윤,기본접근정상피부조직,질지량호;피판온도접근정상피부온도;피판조기유경도종창,1주좌우소퇴.환자균획수방1～36개월,평균20개월;말차수방시피판량점변별각위9～11 mm,평균10 mm.2례원측지간관절강경,경강복단련후회복정상공능.평정수지공능:우10례,량2례. 결론 무지뇨측지고유동맥지배천지피판수복동측무지Ⅰ、Ⅱ도뇨측지단사행결손료효가고,가최대한도보류수지장도급기공능.
Objective To investigate the clinical effect of inherent artery dorsal perforator flaps of thumb radial palmar for coverage of ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.Methods The study included 6 males and 6 females,aged 10-40 years (mean 30 years),with thumb fingertip Ⅰ and Ⅱ degree defect treated between October 2009 and October 2013.Injury resulted from machinery cutting injury in 4 patients,machinery twist injury in 3,cutting by sharp weapons in 3,and crush injury in 2.There were 6 patients with Ⅰ degree defect and 6 patients with Ⅱ degree defect.Defects were all oblique involving more in the radial side rather than in the ulnar side and reconstructed with thumb radial palmar artery perforator flaps.Flap ranged in size from 1 cm × 2 cm to 1.5 cm × 2.5 cm.Donor site was covered with skin grafts.Observation indexes were wound healing condition,flap color,flap swelling degree,and flap temperature.Finger function was measured with upper extremity scoring system formulated by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived and achieved good protective sensation.Wound healed primarily.Color,temperature and texture of the flap returned to almost normal.Moderate swelling of the flaps was detected and subsided around one week.All patients were followed up for 1-36 months (mean 20 months).At the final follow-up,two-point discrimination was 9-11 mm (mean 10 mm).Two patients developed distal interphalangeal joint stiffness and recovered after rehabilitation exercise.Finger function was rated as excellent in 10 cases and good in 2.Conclusion Inherent artery dorsal perforator flap of thumb radial palmar has affirmative effect and allows maximum preservation of finger length and function when applied to repair ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.