CAJ | 학술논문

目的探讨应用长蒂邻指指固有动脉中段背侧支岛状皮瓣修复手指中末节侧方组织缺损的手术方法和临床疗效.方法自2009年8月至2013年10月收治手指中末节侧方组织缺损患者61例66指,男34例,女27例;年龄15～64岁,平均31岁.组织缺损面积为1.3 cm× 1.0 cm～2.8 cm× 2.3 cm.急诊手术56例,二期手术5例.采用长蒂邻指指固有动脉中段背侧支岛状皮瓣移植修复,皮瓣蒂部及邻指供区用游离皮片覆盖.皮瓣携带指固有神经背侧支或指背神经与创面指固有神经断端缝合修复,重建手指感觉.结果术后66指皮瓣全部存活,2～3周顺利断蒂.皮瓣外形满意,质地良好,无色素沉着,两点分辨觉为6～9mm,平均7.8mm.患指及供指捏持正常,屈伸活动良好.供区皮片成活,伤口愈合良好.结论长蒂邻指指固有动脉中段背侧支岛状皮瓣修复手指中末节侧方组织缺损血供可靠,手术操作简便,皮瓣成活率高,术后皮瓣外观良好,患指功能恢复满意.
목적 탐토응용장체린지지고유동맥중단배측지도상피판수복수지중말절측방조직결손적수술방법화림상료효.방법 자2009년8월지2013년10월수치수지중말절측방조직결손환자61례66지,남34례,녀27례;년령15～64세,평균31세.조직결손면적위1.3 cm× 1.0 cm～2.8 cm× 2.3 cm.급진수술56례,이기수술5례.채용장체린지지고유동맥중단배측지도상피판이식수복,피판체부급린지공구용유리피편복개.피판휴대지고유신경배측지혹지배신경여창면지고유신경단단봉합수복,중건수지감각.결과 술후66지피판전부존활,2～3주순리단체.피판외형만의,질지량호,무색소침착,량점분변각위6～9mm,평균7.8mm.환지급공지날지정상,굴신활동량호.공구피편성활,상구유합량호.결론 장체린지지고유동맥중단배측지도상피판수복수지중말절측방조직결손혈공가고,수술조작간편,피판성활솔고,술후피판외관량호,환지공능회복만의.
Objective To investigate the surgical procedure and the clinical efficacy of repairing lateral defect of the middle and distal segments of the finger with long pedicle cross-finger proper digital artery dorsal branch cutaneous flap.Methods Between August 2009 and October 2013, lateral defects of the middle and distal segments of 66 fingers in 61 cases were treated with cross-finger proper digital artery dorsal branch cutaneous flap with a long pedicel.There were 34 males and 27 females.Patients' age ranged from 15 to 64 years with an average of 31 years.The size of the defects ranged from 1.3 cm × 1.0 cm to 2.8 cm × 2.3 cm.Emergent flap transfer was carried out in 56 cases while the other 5 cases were treated by a secondary procedure.The cross-finger island flap was designed on the dorsal digital artery cutaneous branch of the middle phalanx and swung over to cover the defect.The pedicle and donor site were covered with skin graft.The dorsal digital nerve or dorsal branch of proper digital nerve was included in the flap and sutured with the nerve in the wound to restore sensation of the injured finger.Results Postoperatively all 66 flaps survived.The pedicels were severed 2 to 3 weeks pestoperatively.Follow-up period ranged from 8 to 26 months (mean, 12.5 months).Flap appearance and texture were good.There was no pigmentation.Two point discrimination was 6 to 9 nun with an average of 7.8 mm.Pinch and flexion/extension of the fingers were normal.Donor site skin grafts survived, while all the flaps had primary healing.Conclusion Long pedicle cross-finger proper digital artery dorsal branch cutaneous flap has reliable blood supply and is easy to transfer.It is an ideal flap for repairing lateral defect of the middle and distal segments of the finger with high survival rate, good function recovery, and satisfactory appearance.