携带桡神经浅支的示指背侧岛状皮瓣在拇指尺掌侧皮肤缺损中的应用

目的探讨携带桡神经浅支的示指背侧岛状皮瓣修复拇指尺掌侧皮肤缺损的疗效。方法回顾性分析2014年4月—2017年4月华北理工大学附属骨科医院创伤一科采用携带桡神经浅支的示指背侧岛状皮瓣修复拇指尺掌侧皮肤缺损患者15例(随访12例),男性12例,女性3例;年龄23~55岁,平均36.0岁。左手9例,右手6例。受伤至手术时间1.5~8.0h,平均3.5h。拇指尺掌侧皮肤缺损范围5.0cm×2.0cm^7.0cm×2.8cm,均存在不同程度的尺侧指固有神经血管损伤,骨及肌腱外露。皮瓣切取面积6.0cm×2.5cm^8.0cm×3.0cm。结果15例皮瓣均顺利成活,12例获得随访,末次随访拇指功能及外观恢复非常满意9例,满意3例;拇指伤区皮肤感觉恢复S3,两点辨别觉恢复7.0~10.0mm,平均8.5mm,供区无瘢痕挛缩、肌腱粘连、皮肤溃破等并发症。手功能优9指,良2指,可1指,优良率91.6%。结论利用携带桡神经浅支的示指背侧岛状皮瓣修复拇指尺掌侧皮肤缺损,操作简单,皮瓣成活率高,受区感觉恢复良好,是修复拇指尺掌侧缺损较为理想的方法。

Application of rectangular island flap from dorsal index finger with superficial branch of radial nerve in the skin defect of palm and ulnar sides of thumb

Objective To study the clinical effect of the rectangular island flap from dorsal index finger with superficial branch of radial nerve in the skin defect of palm and ulnar sides of thumb.Methods Fifteen patients with skin defect of palm and ulnar sides of thumb were repaired with the rectangular island flap from dorsal index finger with superficial branch of radial nerve in Department of Traumatology,Affiliated Orthopaedic Hospital of North China University of Science and Technology from Apr.2014 to Apr.2017,including 12 males and 3 females aged 23 to 55 years(mean 36.0 years).There were 9 cases in the left hand and 6 cases in the right hand.Injury to surgery time was 1.5-8.0h(mean 3.5h).The thumb skin defect area was 5.0cm×2.0cm-7.0cm×2.8cm,and there were varying degrees of ulnar finger nerve and vascular injury,with bone and tendon exposure.The flap area was 6.0cm×2.5 cm-8.0cm×3.0cm.Results All 15 flaps survived and wound healed.Twelve flaps were followed up.In the last follow-up,9 cases were very satisfied and 3 cases were satisfied of function and recovered appearance of thumb.The skin sensation of the injured area of thumb was restored to S3,two-point discrimination restored to 7.0-10.0mm(mean 8.5mm).There was no complication like scar contracture,tendon adhesions or skin ulceration in donor area.Conclusion It is an ideal method to repair the defect of palm and ulnar sides of the thumb by using the rectangular island flap from dorsal index finger with superficial branch of radial nerve,which is easy to operate,has high survival rate and good sensory recovery in the recipient area.