摘要
目的对比指固有动脉逆行岛状皮瓣和背侧穿支岛状皮瓣修复手指远节末端皮肤缺损的疗效。方法2020年8月~2022年9月收治的手指远节末端皮肤缺损病人128例,患指128根。采用随机数字表法分为侧支组和背支组,每组各64例,侧支组予以指固有动脉逆行岛状皮瓣修复术治疗,背支组予以指固有动脉背侧穿支岛状皮瓣修复术治疗。记录两组手术时间、术中出血量,术后随访12个月,评价移植皮瓣存活率、采用手指总主活动度(TAM)评分评价关节功能、远节移植皮瓣感觉功能、温哥华瘢痕量表评分(VSS)评价瘢痕程度、术后并发症。结果侧支组、背支组病人的手术时间分别为(50.03±12.41)分钟、(54.78±15.65)分钟,术中出血量分别为(22.65±10.03)ml、(26.52±12.61)ml,两组手术时间、术中出血量比较,差异无统计学意义(P>0.05)。术后12个月随访,所有病人远端缺损部分均正常愈合,两组皮瓣移植成功率均为100.00%,两组比较差异无统计学意义(P>0.05)。术后12个月,侧支组、背支组病人的VSS分别为(3.15±0.69)分、(3.17±0.62)分,两组比较差异无统计学意义(P>0.05);侧支组、背支组病人的TAM评分分别为(9.71±0.65)分、(10.93±0.71)分。侧支组TAM评分低于背支组,两组比较差异有统计学意义(P<0.05);侧支组、背支组病人皮瓣两点辨别觉分别为(8.93±2.05)mm、(7.51±1.64)mm,侧支组皮瓣两点辨别觉高于背支组,两组比较差异有统计学意义(P<0.05)。侧支组术后静脉回流障碍2例,不耐寒1例;背支组术后无并发症发生,两组比较差异无统计学意义(P>0.05)。结论与指固有动脉逆行岛状皮瓣修复术比较,指固有动脉背侧穿支岛状皮瓣修复术治疗手指远节末端皮肤缺损,术后手指功能恢复效果更为良好,且静脉回流障碍风险相对更低。
Objective Comparison of therapeutic effects between retrograde island flap of the intrinsic artery and dorsal perforator island flap for repairing skin defects at the distal phalanx of the finger.Methods A total of 128 patients with skin defects at the distal phalanx of the finger were enrolled from August 2020 to September 2022 at Huai’an Second People’s Hospital.These patients had 128 affected fingers.Using a random number table,they were divided into two groups:collateral group(64 case)and dorsal branch group(64 case).The collateral group underwent retrograde island flap surgery using the intrinsic artery,while the dorsal branch group underwent repair surgery using the dorsal perforator island flap of the intrinsic artery.Surgical time and intraoperative blood loss were recorded.Follow-up was conducted for 12 months postoperatively,evaluating graft survival rate,finger joint function,sensory function of the transplanted flap at the distal phalanx,degree of wound scar,and postoperative complications.Results The surgical time for the collateral branch group and the dorsalis branch group was(50.03±12.41)minutes and(54.78±15.65)minutes,respectively.The intraoperative blood loss was(22.65±10.03)ml in the collateral branch group and(26.52±12.61)ml in the dorsalis branch group.There was no statistically significant difference in surgical time or intraoperative blood loss between the two groups(P>0.05).At the 12-month follow-up,all patients in both groups had normal healing of the distal defect,and the success rate of flap transplantation was 100.00%in both groups.There was no statistically significant difference between the groups in terms of flap transplantation success rate(P>0.05).At the 12-month postoperative period,the Vancouver Scar Scale(VSS)score was(3.15±0.69)in the collateral branch group and(3.17±0.62)in the dorsalis branch group,with no statistically significant difference between the two groups(P>0.05).The Tangibility,Appearance,and Mobility(TAM)score was(9.71±0.65)in the collateral branch group and(10.93±0.71)in the dorsalis branch group.The TAM score was significantly lower in the collateral branch group compared to the dorsalis branch group(P<0.05).The two-point discrimination of the flaps was(8.93±2.05)mm in the collateral branch group and(7.51±1.64)mm in the dorsalis branch group.The two-point discrimination was significantly higher in the collateral branch group compared to the dorsalis branch group(P<0.05).There were 2 cases of venous reflux disorder and 1 case of cold intolerance in the collateral branch group,while no complications occurred in the dorsalis branch group.There was no statistically significant difference in complications between the two groups(P>0.05).Conclusion Compared to the reverse island flap repair using the intrinsic arterial system,the dorsal island flap repair using the intrinsic arterial system for treating distal skin defects of the finger provides better postoperative functional recovery of the finger and relatively lower risk of venous congestion.
作者
周鹏
胡浩
黄旭
孟胜东
戴琰琨
ZHOU Peng;HU Hao;HUANG Xu;MENG Shengdong;DAI Yankun(Department of Hand and Foot Surgery,Second People’s Hospital of Huai’an City,Jiangsu Province,Huai’an 223022,China)
出处
《临床外科杂志》
2024年第11期1185-1189,共5页
Journal of Clinical Surgery
关键词
远节手指
皮肤缺损
岛状皮瓣修复术
指侧支动脉
指背侧支动脉
distal finger
distal phalanx
skin defect
island flap repair surgery
collateral artery of the finger
dorsal branch artery of the finger
