同指顺行岛状皮瓣移位修复指腹缺损周礼荣王伟李峻刘迎曦王平【摘要】目的探讨同指带指神经血管蒂顺行岛状皮瓣移位修复指腹缺损的手术效果。方法2003年11月～2005年2月,30例32指指腹缺损患者,男25例,女5例。年龄18～56岁。创面经彻底清创,应用抗生素治疗2～8d后行同指带指神经血管蒂顺行岛状皮瓣移位修复。缺损范围为115cm×112cm～315cm×211cm。皮瓣设计在同指的尺背侧或桡背侧,皮瓣远端距甲根不<5mm,避免损伤甲基质,近端不超过中节指横纹,腹侧切口不超过手指中线,背侧切口不超过手指背中线。切取皮瓣范围为210cm×115cm～410cm×215cm。供区创面切取上臂内侧带真皮下血管网皮片植皮。结果术后30例32个皮瓣全部成活,未发生血管危象。25例获随访2～8个月。皮瓣质地血运良好,外形满意,两点辨别觉7～10mm,手指伸展、屈曲活动功能基本正常。结论同指带指神经血管蒂顺行背侧方岛状皮瓣移位,手术方法简便、安全,效果满意,是修复拇、手指指腹缺损的一种较好方法。【关键词】岛状皮瓣同指指腹缺损修复中图分类号:R622R658.2文献标识码:ATRANSFEROFNEUROVASCULARISLANDFLAPFROMTHESAMEFINGERFORREPAIRINGPULPDEFECT�ZHOULirong,WANGWei,LIJun,etal.HandandMicrosurgeryCenter,BaoShanBranchofShanghaiNo.1AffiliatedHospital,ShanghaiJiaotongUniversity,Shanghai,200940,P.R.ChinaCorrespondingauthor:ZHOULirong,E2mail:guang1934@hotmail.com【Abstract】ObjectiveToobservetheclinicaleffectsofneurovascularislandflapfromthesamefingerforrepairingpulpdefect.MethodsFromNovember2003toFebruary2005,32pulpdefectsin30caseswerecoveredwithneurovascularislandflapfromthesamefinger.Therewere25malesand5females.Theagerangedfrom18to56years.Theoperationwasperformedafterdebridementand228daysantibioticstherapy.Thedefectarearangedfrom1.5cm×1.2cmto3.5cm×2.1cm.Theflapwasharvestedonthedorsalpartofthefingerularlyorradially.Thedistalendoftheflapshouldbemorethan5mmawayfromthenailbasetoavoidnailinjury.Theventralanddorsalcutshouldnotexceedthemiddlelinerespectively.Theflapsizerangedfrom210cm×1.5cmto410cm×2.5cm.Thedonorsitewascoveredwithflapofsubdermalvascularplexusfromthemedialsideoftheupperarm.ResultsAll32transferredflapssurvivedafteroperation.Therewasnovascularcrisis.Twenty2fivecaseswerefollowedupfrom2to8months.Theflapshadgoodappearanceandtextureandbloodcirculation.Two2pointdiscriminationwas7210mm.Thefunctionoffingermotionwasreturnedtonormal.ConclusionTransferofneurovascularislandflapfromthesamefingerofferedasensationalskinflapforreconstructionofpulpdefect.Thetechniquewassimple,andtheclinicalresultwassatisfactory.Itisanidealmethodforreconstructionofthumborfingerpulpdefects.【Keywords】IslandflapSamefingerFingerpulpdefectRepairFoundationitem:ScienceandTechnologyDevelopmentFoundationofBaoshanDistrict,Shanghai(032A232)指腹在手功能中具有十分重要的作用,指腹损伤比较常见,大多需行皮瓣修复。修复方法很多,各有其优、缺点。我们从2003年11月～2005年2月,采用同指带指神经血管蒂顺行岛状皮瓣移位修复指腹缺损30例32指,疗效满意。报告如下。1临床资料1.1一般资料基金项目:上海市宝山区科技发展基金资助项目(032A232)作者单位:上海交通大学附属第一人民医院宝山分院手、显微外科中心(上海,200940)通讯作者:周礼荣,主任医师,研究方向:四肢创伤修复重建,E2mail:guang1934@hotmail.com本组30例32指,男25例,女5例。年龄18～56岁,平均35.5岁。致伤原因:电刨伤、钢缆伤、电锯伤、钢板及钢管压伤各1例,电击伤2例,机械伤23例。受伤部位:拇指8例8指(左、右各4指),食指8例9指(右4指、左5指),中指9例10指(右6指、左4指),环指5例5指(右2指、左3指);其中2例为食、中指双指损伤。指腹缺损范围为115cm×112cm～315cm×211cm,均伴骨、肌腱外露。均采取亚急诊手术。患者入院时,伤口均污染较重。创面按常规...
