指背逆行岛状皮瓣修复指端皮肤缺损的护理

指端皮肤软组织缺损是一种很常见的损伤，其治疗方法很多。指固有动脉背侧支为蒂的指背逆行岛状皮瓣，修复指端皮肤软组织缺损，克服了邻指、交臂皮瓣等需二次手术、治疗周期和指间关节固定时间长，容易造成手指关节功能障碍的缺点，且无需牺牲一侧的指固有动脉。我院于2007年10月至2009年1月应用指背逆行岛状皮瓣为8例指端皮肤软组织缺损的患者进行修复术，做好围手术期的观察和护理对保证皮瓣移植的成功至关重要，现就护理体会报告如下。     

小型皮瓣在手指软组织缺损的应用

目的：探讨手指各部位软组织缺损最佳皮瓣修复方法。方法：采用示指岛状皮瓣，手背逆行岛状皮瓣，邻指背随意皮瓣，指固有动脉为蒂手指方岛状皮瓣及V－Y皮瓣修复手指各部位缺损40例，结果：示指背岛状皮瓣修复拇指皮肤缺损8例，手背逆行岛状皮瓣修复示，中指皮肤缺损5例，指周有动脉为蒂指侧方岛状皮瓣修复中，环指皮肤缺损5例，邻指背随意皮修复示，中、环、小指指腹缺损12例，皮瓣全部成活，V－Y皮瓣修复指端缺损10例，除2例V－Y，皮瓣远端出现部分坏死，经换药后愈合外，其余全部成活。结论：手指皮肤缺损采用局部邻近部皮瓣修复具有损伤小，操作简单，疗效佳，疗程短等优点，部分患者可以同时Ⅰ期修复肌腱缺损和进行功能重建。     

中节指背筋膜皮瓣修复邻指皮肤缺损8例分析

目的：应用中节指背筋膜皮瓣修复邻指皮肤缺损。方法：根据指背筋膜的供血特点,于邻近手指中节指背一侧设计筋膜皮瓣,皮瓣侧缘不超过手指同侧指动脉,轴点位于两指的指蹼处,轴心线与手指侧方纵轴平行。我科2000-03/2003-06应用该术式修复邻指皮肤缺损8例。急诊7例,择期1例,皮瓣面积为1.2 cm×1.7 cm-1.5 cm×2.3 cm。结果：皮瓣全部成活,两例远端出现0.5 cm大小水泡,随访8-15个月,平均11个月。结论：此术式不损伤手指主要血管、神经,简单、安全、创伤小,一次完成。     

指背逆行筋膜蒂岛状皮瓣修复指端缺损的疗效观察

目的 探讨指背逆行筋膜蒂岛状皮瓣修复指端缺损的方法和临床疗效。方法 对2015年5月～2019年2月我院采用指背逆行筋膜蒂岛状皮瓣对21例(24指)远节皮肤软组织缺损面积较大的患者进行创面修复。观察修复效果。结果 本组皮瓣全部成活,其中3例术后皮瓣出现水泡,1例皮瓣远端部分坏死。全部获得随访,随访时间3～12个月,患者均对患指外形感到满意。末次随访时皮瓣两点间分辨觉为3～6.5(平均4.7)mm。术后手功能按TAM评定法,优16指,良6,可2指,优良率91.7%。结论 指背逆行筋膜蒂岛状皮瓣手术相对简单,损伤较小,并发症少,指端感觉良好,是一种修复手指远节皮肤软组织缺损效果较理想的手术方法,值得推广应用。     

远端蒂掌指背皮神经营养血管皮瓣修复手指皮肤缺损

目的应用手部掌指背皮神经营养血管皮瓣修复手指皮肤缺损。方法采用远端蒂掌指背皮神经营养血管皮瓣修复手指皮肤缺损15例,共15指。皮瓣面积为(1.2～2.5)cm×(1.5～4.2)cm,旋转点在近侧指间关节近侧0.5 cm平面。结果 15例皮瓣均完全成活,随访3～12个月,外形及功能均良好。结论远端蒂掌指背皮神经营养血管皮瓣修复手指皮肤缺损血供可靠,操作简单,疗效满意,值得在各级医院包括基层医院推广应用。     

三种不同微型皮瓣修复手指掌侧功能区皮肤缺损的临床效果分析

目的探讨三种不同微型皮瓣修复手指掌侧功能区皮肤缺损的疗效。方法 2010年10月至2014年3月,本组收治46例52指手指掌侧单纯皮肤缺损的患者,缺损面积1.0 cm×1.5 cm~2.5 cm×5.0 cm。致伤原因:碾压伤10例,压砸伤19例,机器绞伤14例,化学烧伤3例。采用指固有动脉逆行岛状皮瓣修复16指、指背皮神经营养血管筋膜蒂皮瓣修复24指、游离第二足趾侧方皮瓣修复12指,皮瓣供区取全厚皮片植皮修复。结果术后指固有动脉逆行岛状皮瓣均顺利成活,指背皮神经营养血管筋膜蒂皮瓣部分坏死2例,经过换药愈合,游离第二足趾侧方皮瓣发生动脉危象1例,经过血管探查吻合成活。随访6~24个月,末次随访两点辨别觉恢复以游离第二足趾侧方皮瓣修复最佳,为5~6 mm。根据中华医学会手外科学会上肢部分功能评定标准评定,优37指,良10指,可5指。其中指固有动脉逆行岛状皮瓣修复优9指、良4指、可3指,指背皮神经营养血管筋膜蒂皮瓣修复优16指、良6指,可2指,游离第二足趾侧方皮瓣修复12指均为优。结论游离第二足趾侧方皮瓣修复指掌侧皮肤缺损能最大限度地恢复手指形态、功能,且供区隐蔽,效果最佳。指固有动脉逆行岛状皮瓣、指背皮神经营养血管筋膜蒂皮瓣操作安全、简单,适合基层医院开展。     

拇指指背动脉岛状皮瓣修复拇指远端软组织缺损的护理

本院应用拇指指背动脉岛状皮瓣逆行修复拇指远端软组织缺损，并将皮瓣内指背神经与拇指指神经进行外膜缝合，术后恢复了部分感觉功能，外形良好，现将护理要点报告如下。1临床资料本组35例，男25例，女10例；年龄18—45岁，平均25岁。均为机器致伤的拇指远端软组织缺损，且伴有骨外露。应用拇指背侧指动脉岛状皮瓣逆行修复拇指远端软组织缺损，术后有3例皮瓣出现水疱，其中1例皮瓣颜色暗紫，考虑是皮瓣蒂部卡压影响静脉回流所致，予适当拆线后，     

前臂逆行岛状皮瓣修复手部皮肤缺损分析

目的观察前臂逆行岛状皮瓣移植修复手部皮肤软组织缺损的临床效果。方法1990年1月至2007年12月，采取多种前臂逆行岛状皮瓣转位移植修复手部皮肤软组织缺损18例，在前臂远端设计皮瓣，依据皮肤软组织缺损的部位分别选用不同皮瓣。其中桡动脉逆行岛状皮瓣7例、桡浅神经伴行营养血管逆行岛状皮瓣2例、桡浅神经伴行营养血管逆行岛状皮瓣2例、骨间背动脉逆行岛状皮瓣移植4例、骨问背动脉桡侧皮支逆行岛状皮瓣1例、尺动脉腕上支逆行岛状皮瓣2例、尺神经尺动脉背支为蒂的逆行岛状皮瓣2例。结果3例皮瓣远端部分坏死，成活15例。经6～18个月的随访，皮瓣血运、弹性、质地良好，皮瓣面积最小为3cm×3．5cm，最大为10cm×14cm，修复后的手指外观满意。结论前臂逆行岛状皮瓣移植是修复手部皮肤软组织缺损的最佳皮瓣之一。     

示指桡侧指背动脉逆行岛状皮瓣移植修复示指缺损

目的:观察示指桡侧指背动脉逆行岛状皮瓣移植对示指指端缺损的修复效果。方法:选择2002-08/2005-09南华大学附属第一医院急诊收治的外伤性示指末节部分缺损患者13例,手术方法的选择在术前均得到患者同意,且得到医院伦理道德委员会批准。组织缺损大小在1.5cm×1.0cm～2.0cm×1.5cm之间,所有缺损均有指骨和(或)大部分的指腹组织缺损,采用示指桡侧指背动脉逆行岛状皮瓣移植修复,皮瓣设计:旋转点位于近侧指间关节的近端,皮瓣轴为示指的桡背侧,皮瓣部分设计在第2掌指关节的近侧,蒂宽约0.8mm。术后定期随访,主要观察皮瓣质地和感觉的恢复情况,将感觉恢复的评估标准分为5级:S1:无感觉;S5:在神经单一分布区恢复两点鉴别能力。结果:13例患者全部进入结果分析,无脱落。①术后随访三四个月者10例,随访五六个月者3例。②术后9例皮瓣完全成活;4例皮瓣远端部分坏死,经换药表皮爬行创面愈合。③外形基本满意,皮瓣色泽、质地良好。④术后1个月随访时,3例患者两点辨别觉大于6.0mm,感觉恢复S4;术后五六个月随访时,3例患者两点辨别觉4.0～6.0mm,感觉恢复S5。结论:示指桡侧指背动脉逆行岛状皮瓣设计的旋转点位于近侧指间关节的近端,可以简化手术而不影响皮瓣存活,是示指部分缺损修复的可选方法。     

手部带血管蒂皮瓣的临床应用

自1990年以来，我们应用手部带血管蒂皮瓣转移修复手指皮肤缺损50例，虎口皮肤缺损6例，效果满意。报告如下。1临床资料本组50例中男30例，女26例。年龄7～52岁，平均32岁。虎口皮肤缺损范围最大3．0cm×6．0cm，最小2．0cm×4．5cm。手指皮肤缺损情况见附在。皮瓣选用①食指背侧皮瓣修复虎口皮肤缺损；②指固有动脉顺行指测方皮瓣或掌背动脉颁行皮瓣修复拇指皮肤缺损；③指固有动脉逆行皮瓣修复2～5指未节指腹或指端皮肤缺损；④含指神经背侧支的指固有动脉蒂指背皮瓣修复指掌侧皮肤缺损；⑤掌背动脉逆行皮瓣修复指背皮肤缺损。皮瓣成活54…     

The Kleinert modified dorsal finger splint for mallet finger fracture

Injuries to the hand and digits are commonly seen in the emergency department. Lacerations, contusions, puncture wounds, and fractures comprise the bulk of these injuries. A fracture to the dorsum of the distal phalanx can result in a mallet finger deformity. These fractures must be accurately diagnosed with the proper initial treatment begun. There is some disagreement over the best treatment approach and multiple different splints have been described in the literature. Conservative treatment with a finger splint is most commonly effective. We recommend a modified dorsal finger splint for these injuries. We describe a splint to properly treat the fracture, prevent complications, maximize patient comfort during rehabilitation, and prevent mallet finger deformity.     

逆行指固有动脉背侧支皮瓣修复手指指端缺损

目的探讨应用指动脉远侧指间关节背侧支逆行岛状皮瓣修复手指指端缺损的方法和疗效。方法本院于2010年6月--2012年3月期间应用指动脉远侧指间关节背侧支逆行岛状皮瓣修复手指指端缺损并指骨外露患者16例,其中食指10例,中指4例,环指2例。皮瓣切取范围1．0cm×2．6cm--1．5cm×3．6cm。结果本组有5例患者皮瓣术后出现水疱,3例皮瓣淤血,2例皮瓣远端部分坏死,经换药后愈合,其余全部成活,且供区伤口皮瓣完全成活。平均随访6个月,静态2点辨别觉6--8mm,手指外观及功能均满意。结论该皮瓣操作简便,不损伤指固有动脉及神经,成功率高,是修复指端软组织缺损的一种有效治疗方法。     

皮神经筋膜蒂岛状皮瓣修复再植后手指皮肤缺损的护理体会

目的探讨应用掌指背皮神经筋膜蒂岛状皮瓣修复再植术后手指皮肤缺损的临床护理。方法对实施掌指背神经的筋膜蒂岛状皮瓣逆行旋转修复再植手指皮肤缺损的19例患者资料进行回顾性总结,护理措施包括术前准备,术后护理,皮瓣观察,舒适护理,功能锻炼及追踪随访。结果 19例皮瓣全部成活,无护理并发症。随访1～12个月,外观良好、质地柔软、色泽正常,手指功能按TAM法评定,优12例、良5例、可2例,优良率达89.5%。结论掌指背皮神经筋膜蒂岛状皮瓣是再植手指术后皮肤缺损的良好选择,根据病例特点实施针对性干预护理,可提高手术成功患者的手功能恢复。     

Conduction of the dorsal digital branches of the radial nerve to the long finger

Orthodromic conduction of the radial nerve digital branches to the third digit from the anatomic snuffbox has rarely been described. This paper describes a technique for measuring conduction of the lateral and medial digital branches of the radial nerve to the third digit at a distance of 10cm from the base of the digit to the anatomic snuffbox. An evoked response from the lateral digital branch was recorded in each of the 56 nerves tested. Responses had an average latency of 2.10 +/- .18msec. Responses from the medial digital branches of the nerve were obtained in only 55% of the 49 nerves tested. Responses had an average latency of 2.11 +/- .21msec. When no appreciable response was recorded at the anatomic snuffbox from the medial digital branch, a response was recorded from the ulnar nerve at the volar wrist at 14cm.     

手损伤行掌背动脉逆行蒂岛状皮瓣移植术的护理

掌背动脉逆行蒂岛状皮瓣移植术在手外科中运用较为广泛,但手术后期容易出现皮瓣坏死,给患者新的软组织造成不同程度的畸形和缺失。术前给予患者心理护理,术后对患者进行患肢护理、皮瓣的观察、皮温监测、疼痛的护理。有效的术前和术后护理,是手术成功的保证。     

Neurovascular responses to sequential deep inspirations assessed via laser-Doppler perfusion changes in dorsal finger skin

A vasomotor reflex triggered by a rapid and deep inspiration causes arteriolar vasoconstriction and a transient decrease in skin blood flow in most people. This is the inspiratory gasp vascular response (IGVR). The most common site of its measurement has been on the palmar or plantar aspect of the digits and little is known about its features in skin with few or any arterial venous anastomoses (AVAs). A basic aspect of this response that has not been systematically studied is its associated with multiple sequential inspiratory gasps (IG) in the same person. Such information would provide insight as to whether there is any form of adaptation or temporal dependence and may serve as a basis for judging response variability. Thus, the present study was undertaken to characterize the normal pattern of responses in finger dorsum skin in a group of 28 normal persons who performed 21 sequential, uniformly spaced IG, over an interval of 42 min. The results show that IGVR measured on the finger dorsum have a magnitude comparable with that obtained on finger pulp, in spite of the relative dearth of sympathetically controlled AVAs on the dorsum. It was also found that the magnitude of the IGVR displays little if any tendency for sequential adaptation or temporal trending. Finally, the results indicate that the largest component of response variability is associated with subject-to-subject differences as compared with sequential variability within subjects.     

Somatotopic organization of the ventral and dorsal finger surface representations in human primary sensory cortex evaluated by magnetoencephalography.

Cortical reorganization of the subtly differentiated hand map after peripheral nerve injury might be better understood if there was a topographic conception of the homuncular representation of the dorsal finger surfaces in humans, in addition to the well-established sequential rostrocaudal array of the ventral finger aspects in cortical area 3b. In the present magnetoencephalographic study, tactile pneumatic stimulation was delivered to the fingertip and to the ventral and dorsal proximal phalanx of each digit of the dominant hand in 20 right-handed volunteers. Source localization of equivalent current dipoles underlying the recorded somatosensory evoked magnetic field was performed using a Cartesian coordinate system established by the anatomical landmarks nasion and preauricular points. Of the first major peak of each somatosensory evoked field, the region with the maximum field power (root-mean-square across channels) was selected for source reconstruction. Analysis of variance for repeated measures yielded significant results with respect to the arrangement of digits along the vertical coordinate axis, demonstrating a sequential array from the most inferiorly located D1 to the most superiorly located D5 for all different stimulus positions. This is the first study providing evidence for a sequential topographical arrangement of not only the ventral but also the dorsal surface representations of the individual digits in the human somatosensory cortex. The study contributes to a better understanding of the somatosensory hand representation in human primary cortex and provides useful information with regard to cortical plasticity studies in patients with peripheral nerve injuries at the upper extremity.     

A review of mallet finger and jersey finger injuries in the athlete

Purpose of review

The purposes of this review are to discuss the diagnosis and management of mallet and jersey finger injuries in athletes and to highlight how treatment impacts return to play.

Recent findings

Mallet finger: although numerous non-operative and operative techniques have been described, there continues to be little consensus regarding the optimal procedure. Jersey finger: ultrasound appears to be a cost-effective imaging modality that may be useful for preoperative planning. Wide-awake surgery offers optimal intraoperative assessment of the tendon repair. Tendon repair with volar plate augmentation has been shown to improve the strength of the repair in the laboratory, and early clinical results are encouraging.

Summary

Most mallet finger injuries will heal with non-operative treatment over a period of 8–12 weeks, even when treatment is delayed up to 3–4 months. An acute diagnosis of jersey finger requires surgical treatment and generally means 8–12 weeks of inability to compete in most contact sports.