微型皮瓣修复手指指腹缺损(1)
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[摘要]目的：报道六种微型皮瓣修复手指指腹缺损的临床效果。方法：急诊对52例60指手指指腹缺损患者，分别采用六种皮瓣进行修复，其中邻指皮瓣8例8指，指动脉逆行岛状皮瓣9例10指，指背神经营养筋膜皮瓣9例11指，游离尺动脉腕上皮支下行支皮瓣8例8指，游离足第二趾侧方皮瓣9例14指，游离趾腹皮瓣9例9指，并进行随访，比较临床效果。结果：本组皮瓣均一期成活，伤口均一期愈合，经过6～20个月随访(平均10个月)，采用第二趾侧方皮瓣及趾腹皮瓣感觉恢复最好，2pd(两点辨别觉)4～6mm，其次游离尺动脉腕上皮支下行支皮瓣2pd7～9mm皮瓣外形、质地均比较满意。结论：带感觉神经的微型游离皮瓣是修复手指指腹缺损最为理想的手术方法，可以恢复指腹的精细感觉。
[关键词]外科皮瓣；指损伤；感觉重建；显微外科技术
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)02-0205-03
Repair of finger pulp defects with micro-flaps
YUAN Xin-wen1,JU Ji-hui2,JIANG Guo-dong1
(1.Department of Hand Surgery,Ruixing Hospital, Ruixing 215004,Suzhou,China；2.Ruihua Affiliated Hospital of Soochow University)
Abstract: Objective To report the clinical effect of six kinds of finger pulp defects repair with mini-flaps. Methods 52 cases of emergency and 60 fingers with pulp defects were repaired with six kinds of flaps,of which 8 cases with 8 adjacent finger flaps,9 cases 10 fingers with artery retrograde island flaps,9 cases 11 fingers with dorsal fascia neurotrophic flaps, 8 cases 8 fingers with flaps of the wrist cutaneous branch of free ulnar artery,9 cases 14 fingers with free toe flaps of the second toe side,9 cases 9 fingers with free toe flaps,and conduct follow-up to compare the clinical results. Results All the flaps were primary healing, and all the wounds were primary healing,after 6 to 20 months follow-up (mean 10 months),it turned out that using the free toe flaps of the second toe side and free toe flaps yielded best sensory recovery,2pd4～6mm,the second choice was flap of the wrist cutaneous branch of free ulnar artery,2pd7 ～9mm,with sound flap shape and satisfying texture. Conclusion Applying mini-free flaps with sensory nerve to repair finger pulp defects is the most ideal surgical approach to restore fine feeling of pulps.
Key words:surgical flaps; finger injuries; feeling reconstruction; microsurgical techniques
指腹缺损是临床上常见的损伤，有多种修复方法，也取得了满意的临床效果。自2002年8月到2009年12月以来，我院采用六种微型皮瓣修复指腹缺损52例60指，术后皮瓣均成活，取得满意的临床效果，现报道如下。
1 资料和方法
1.1 一般资料:本组52例60指，男30例，女22例，年龄18～42岁，平均28岁，损伤指别：拇指6指，示指18指，中指16指，环指15指，小指5指，损伤原因：切割伤20例，冲压伤18例，绞伤8例，其它6例，均为指腹缺损，缺损面积：1.5㎝×1.2㎝～4.0㎝×2.0㎝，邻指皮瓣8例8指，指动脉逆行岛状皮瓣9例10指，指背神经筋膜皮瓣9例11指，游离尺动脉腕上皮支下行支皮瓣8例8指，游离足第二趾侧方皮瓣9例14指，游离趾腹皮瓣修复9例9指。
1.2 手术方法:麻醉满意后，术区常规刷洗，消毒，铺巾后 ......
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