筋膜血管神经蒂掌指背岛状皮瓣的临床应用

目的 探讨筋膜血管神经蒂掌指背岛状皮瓣修复手部软组织缺损的临床效果。方法 设计以掌骨桡侧或尺侧掌背动脉、神经及其筋膜为蒂，邻指掌指背岛状皮瓣修复手指近节掌或背、掌背及拇指近远节掌或背软组织缺损，有深部组织外露创面。修复拇手指38例，其中修复拇指末节30例，修复拇指近节4例，修复拇指近末节1例，修复中指近节背1例，修复中指掌指背缺损1例，修复示指近节背缺损1例。术后均结合康复功能训练。结果 皮瓣全部成活，且有良好感觉，术后供区活动无影响，受区活动功能按TAM评定优良率为97％，术后2～24个月平均10个月随访，皮瓣色泽、质地与受区相同，无挛缩及臃肿。结论 筋膜血管神经蒂掌指背岛状皮瓣的方法操作简单、安全可靠，手术一次完成，易于掌握，术后皮瓣外形美观、质地良好；而且住院时间短、费用低、损伤小，易于推广。

Clinical application of dorsal carpometacarpal island flap with fascia vessel and nerve

Objective To present the clinical effect of dorsal carpometacarpal island flap with fascia, vessel and nerve to repair soft tissue defected. Methods The island flap was designed with mot of fascia, dorsal metalcarpals artery and nerve. The flap to soft tissue defected in the nearby area was applied, including 30 cases in the last segment of thumb, 4 cases in the first segment of thumb, 1 case in the IP articulation of thumb, 1 case in the first segment of middle finger, 1 case in the carpometacarpal dorsal area and 1 case in the back of index finger. Results Thirty- eight cases were survived. All cases obtained good appearance and sensory recovery approach normally with little affection in supply area. Conclusions This method has advantage of simple, practical, high survive rate, low impairment, sensible and good appearance.