V-Y推进皮瓣联合其他皮瓣修复拇指末节损伤△

V-Y advanced flap combined with another flap for repairing degloving injury or amputation of distal thumb

摘要:

［目的］ 探讨 V-Y 推进皮瓣联合指背动脉逆行岛状皮瓣瓦合修复拇指末节离断伤或脱套伤的临床疗效。［方法］ 回顾性分析 2017 年 3 月—2019 年 8 月收治的无再植条件的拇指末节离断伤或脱套伤 23 例患者的临床资料。10 例为无再植条件的拇指末节离断伤，13 例为末节脱套伤。分别采用 V-Y 推进皮瓣与指背动脉逆行岛状皮瓣修复伤指掌、背侧创面。2 块皮瓣供区直接缝合。［结果］46 块皮瓣全部成活，V-Y 推进皮瓣面积为 1.8 cm × 0.6 cm~2.5 cm × 1.8 cm，指背动脉逆行岛状皮瓣面积为 2.2 cm ×1.5 cm~3.0 cm × 2.6 cm。随访时间 8~18 个月，平均（12.30±2.46）个月。拇指末节外观良好，指端无疼痛、耐寒；背侧供区仅残留线性瘢痕。皮瓣静态两点辨别觉： V-Y 推进皮瓣为 4~7 mm，指背动脉逆行岛状皮瓣为 5~9 mm。伤指总活动度与健侧拇指比较差异无统计学意义。手部外观评定：15 例非常满意，8 例满意。［结论］V-Y 推进皮瓣联合指背动脉逆行岛状皮瓣修复拇指末节离断伤或脱套伤，操作简便，供区损伤小，临床疗效满意。

Abstract:

[Objective] To explore the clinical outcomes of V-Y advanced flap combined with reversed dorsal digital artery island flap for repairing degloving injury or amputation of distal thumb. [Methods] From March 2017 to August 2019, 23 patients were surgically treat- ed for degloving injury or amputation of distal thumb without indication of replantation. Of them, 10 patients had traumatic amputation, while 13 patients were of degloving injury of distal thumbs. V-Y advanced flap combined with a reversed dorsal digital artery island flap was used to repair the volar and dorsal defects of distal thumb respectively, with direct closure of donor-site defects of the two flaps. [Results] All flaps survived uneventfully in the 23 patients. The follow-up period lasted from 8 to 18 months with an average of (12.30±2.46) months. The appearance of the distal thumbs looked good, without pain and cold intolerance at the fingertip of the thumb, whereas only lin- ear scars were remained at donor site of the dorsal thumb in all the patients. The static 2-point discrimination of the V-Y advanced flap and reversed dorsal digital artery island flap ranged from 4 to 7 mm and 5 to 9 mm respectively. There was no statistical difference of the to- tal range of motion between the injured and healthy thumbs (P＞0.05) . Based on the criteria of the hand appearance evaluation, 15 patients were satisfied very much, and 8 patients were satisfied. [Conclusion] The V-Y advanced flap combined with reversed dorsal digital artery island flap is a good option for repairing degloving injury or amputation of distal thumb, with advantages of simple operation, less donor-site morbidity and satisfactory clinical results.