CAJ | 학술논문

目的探讨近节指背动脉蒂邻指岛状皮瓣修复手指皮肤缺损并重建感觉的临床治疗效果. 方法选择2013年1月-2014年1月21例(21指)手指皮肤缺损患者,采用近节指背动脉蒂邻指岛状皮瓣进行修复并重建感觉.损伤指别:示指7例,中指9例,环指4例,小指1例.手指皮肤软组织缺损面积为1.9 cm×1.5 cm～4.3 cm×2.3 cm.皮瓣切取面积为2.0 cm×1.7 cm～4.5 cm×2.5 cm.皮瓣供区均采用上臂内侧全厚皮片进行修复.术后观察皮瓣存活情况及修复外观,并检测两点辨别觉.根据手外科功能评分系统(TAM)对指功能进行评价. 结果术后所有皮瓣及植皮成活.所有患者均获得6～18个月(平均14.7个月)随访.末次随访时,患指外观恢复满意,未见明显瘢痕挛缩或色素沉着,皮瓣供区饱满,未见明显凸起或凹陷,指蹼开大与健侧无明显差异,皮瓣两点辨别觉为5～9mm(平均6.3mm).TAM评价:优19例,良2例,优良率为100％. 结论携带指背神经的近节指背动脉蒂邻指岛状皮瓣修复手指皮肤缺损,具有成活率高、术后外观及感觉恢复满意、并发症少等优点,是治疗手指皮肤缺损较为理想的方法.
목적 탐토근절지배동맥체린지도상피판수복수지피부결손병중건감각적림상치료효과. 방법 선택2013년1월-2014년1월21례(21지)수지피부결손환자,채용근절지배동맥체린지도상피판진행수복병중건감각.손상지별:시지7례,중지9례,배지4례,소지1례.수지피부연조직결손면적위1.9 cm×1.5 cm～4.3 cm×2.3 cm.피판절취면적위2.0 cm×1.7 cm～4.5 cm×2.5 cm.피판공구균채용상비내측전후피편진행수복.술후관찰피판존활정황급수복외관,병검측량점변별각.근거수외과공능평분계통(TAM)대지공능진행평개. 결과 술후소유피판급식피성활.소유환자균획득6～18개월(평균14.7개월)수방.말차수방시,환지외관회복만의,미견명현반흔련축혹색소침착,피판공구포만,미견명현철기혹요함,지복개대여건측무명현차이,피판량점변별각위5～9mm(평균6.3mm).TAM평개:우19례,량2례,우량솔위100％. 결론 휴대지배신경적근절지배동맥체린지도상피판수복수지피부결손,구유성활솔고、술후외관급감각회복만의、병발증소등우점,시치료수지피부결손교위이상적방법.
Objective To assay the clinical effect of proximal dorsal digital artery pedicled island flap in treatment and sensory reconstruction of adjacent finger soft-tissue defect.Methods The study enrolled 21 cases of soft-tissue defect in 21 fingers treated from January 2013 to January 2014.All the defects were covered with the proximal dorsal artery pedicled island flaps raised from the adjacent finger.Index finger was injured in 7 patients,middle finger in 9 patients,ring finger in 4 patients,and little finger in 4 patients.Defect and flap dimensions varied from 1.9 cm × 1.5 cm to 4.3 cm × 2.3 cm and from 2.0 cm × 1.7 cm to 4.5 cm × 2.5 cm respectively.Donor site was resurfaced with a fullthickness skin harvested from medial side of the upper arm.Postoperative flap appearance and two-point discrimination were evaluated.Total active motion (TAM) of the finger was evaluated after operation.Results All the flaps and skin grafts survived after operation.Duration of the follow-up was 6-18 months (mean,14.7 months).Through the final follow-up,appearance and function of the flap were satisfactory,donor site healed well,and two-point discrimination was 5-9 mm (mean,6.3 mm).TAM evaluation was excellent in 19 patients and good in 2 patients with the excellent-good rate of 100％.Conclusion The proximal dorsal artery pedicled island flap raised from the adjacent finger is an ideal choice in finger soft-tissue reconstruction,for the technique has advantages of high survival rate,satisfactory appearance and sensory function as well as few complications.