摘要
目的 比较同指指动脉背侧支皮瓣与掌背动脉皮瓣急诊修复手指中末节背侧软组织缺损的效果。方法 回顾性分析2017年9月—2020年9月唐山市第二医院手外科收治手指中末节背侧皮肤软组织缺损患者34例(34指),按照修复术式不同将患者分为同指指动脉背侧支皮瓣组(19例19指)和掌背动脉皮瓣组(15例15指)。同指指动脉背侧支皮瓣组:男性12例,女性7例;年龄22~60岁,平均44.7岁;绞伤4例,压砸伤7例,电锯伤及切割伤8例。掌背动脉皮瓣组:男性11例,女性4例;年龄19~58岁,平均42.7岁;绞伤4例,压砸伤5例,电锯伤及切割伤6例。比较两组患者皮瓣静态两点辨别觉、近指间关节与掌指关节活动度、皮瓣及供区外观满意度等指标。结果 两组患者皮瓣均顺利成活,随访时间12~18个月,平均14.9个月。两组患者一般资料、手术时间与随访时间比较差异无统计学意义(P>0.05)。同指指动脉背侧支皮瓣组皮瓣静态两点辨别觉为(9.2±1.4) mm(8~11mm)显著优于掌背动脉皮瓣组的(10.4±1.7)mm(8~12mm)(t=-2.455,P=0.020);近指间关节与掌指关节活动度(186.3°±10.9°)(155°~200°)与掌背动脉皮瓣组(185.7°±10.7°)(160°~200°)比较差异无统计学意义(t=0.174,P=0.863);患者对术后伤指皮瓣外观满意度Michigan手部问卷评分(3.9±0.9)分(3~5分)优于掌背动脉皮瓣组的(3.4±0.8)分(3~5分)(t=2.146,P=0.040);患者对供区术后外观满意度Michigan手部问卷评分(4.4±0.7)分(3~5分)优于掌背动脉皮瓣组的(3.9±0.6)分(3~5分)(t=2.396,P=0.023)。结论 修复手指中末节背侧软组织缺损时,两种皮瓣均适用,且安全可靠。相较于掌背动脉皮瓣而言,同指指动脉背侧支皮瓣能更好地重建伤指的感觉与外观,临床效果更佳。
Objective To compare the emergency repair effect of soft tissue defects involving middle and lower parts of the finger by using dorsal branch(DB)flaps based on the same finger digital artery vs.dorsal metacarpal artery(DMCA)flap.Methods A retrospective analysis was performed on 34 patients(34 fingers)with dorsal skin and soft tissue defects involving the middle and distal parts of fingers admitted to the Hand Surgery Department of Tangshan Second Hospital from Sep.2017 to Sep.2020.Patients were divided into DB flap group,where DB flaps of the same finger artery were used for repair of 19 fingers(n=19),and DMCA flap group where DMCA flap was applied to 15 fingers(n=15).In the DB flap group,there were 12 males and 7 females aged 22-60 years,mean 44.7 years,including 4 cases of strangulation injuries,7 crushing injuries and 8 electric saw injuries.In the DMCA flap group,there were 11 males and 4 females aged 19-58 years,mean 42.7 years,including 4 cases of strangulation injuries,5 crushing injuries and 6 electric saw injuries.The static two-point discrimination of skin flap,range of motion of the proximal interphalangeal joint and metacarpophalangeal joint,and appearance satisfaction for skin flap and donor site were compared between two groups.Results Flaps in both groups survived successfully.The follow-up period was 12-18 months,mean 14.9 months.There were no significant differences in general data,operation time and follow-up time between the two groups(all P>0.05).In DB flap group,the static two-point discrimination of flaps was(9.2±1.4)mm(range 8-11 mm),significantly better than that in DMCA flap group,i.e.,(10.4±1.7)mm(range 8-12 mm)(t=-2.455,P=0.020);the range of motion of proximal interphalangeal joint and metacarpophalangeal joint was(186.3°±10.9°,155°-200°),similar to that of DMCA flap group(185.7°±10.7°,160°-200°)(t=0.174,P=0.863).The Michigan Hand Questionnaire was used to assess the degree of satisfaction for the skin appearance,which showed a significantly better score in DB flap group than in DMCA flap group,both for the recipient site[3.9±0.9(range 3-5)vs.3.4±0.8(range 3-5);t=2.146,P=0.040]and the donor site[4.4±0.7(range 3-5)vs.3.9±0.6(range 3-5);t=2.396,P=0.023].Conclusion The DB flap based on the same finger artery and the DMCA flap have stable blood supply and are safe and reliable to repair the dorsal soft tissue defects involving the middle and lower parts of the finger.Compared with DMCA flap,DB flap based on the same finger artery can achieve a better sensation and appearance,and thus superior in clinical reconstruction.
作者
张一晗
王辉
王红涛
贾鑫玮
Zhang Yihan;Wang Hui;Wang Hongtao;Jia Xinwei(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan,Hebei 063000,China)
出处
《创伤外科杂志》
2023年第6期427-431,452,共6页
Journal of Traumatic Surgery
基金
河北省医学科学研究课题计划项目(20201453)
河北省医学适用技术跟踪项目(GZ2021030)
唐山市科技计划项目(22150219J)。
关键词
软组织缺损
指动脉背侧支皮瓣
掌背动脉皮瓣
手指
急诊修复
Soft tissue defects
Dorsal branch flap based on digital artery
Dorsal metacarpal artery flap
Fingers
Emergency repair
