第二趾趾端复合组织串联趾侧方皮瓣修复指端缺损的基础与临床研究

发布时间：2018-03-29 06:25

本文选题：指损伤　切入点：趾　出处：《苏州大学》2015年硕士论文

【摘要】：目的:探索第二趾趾端复合组织串联趾侧方皮瓣修复指端缺损的血管解剖学基础及临床应用疗效。方法:研究包括基础研究和临床应用两部分。基础研究包括尸体解剖:本研究采用6侧新鲜成人下肢肢体,其中4侧采用红色乳胶进行动脉灌注,2侧冰冻尸体解冻后直接解剖。在显微镜下解剖趾足底固有动脉,远端至趾端。用游标卡尺测量趾足底固有动脉穿支发出的部位及口径。临床对16例16指拇、手指指端复合组织缺损的患者,设计以趾足底固有动脉—甲皱襞血管筋膜蒂为蒂的第二趾趾端复合组织串联趾侧方皮瓣进行瓦合修复。结果:所有的标本中均可发现趾足底固有动脉及其终末甲床支及骨纤维支。趾足底固有动脉于甲皱襞以近7.6±0.7mm处发出终末甲床支,于甲皱襞以近3.3±0.1mm处发出骨纤维支。它们与甲周表皮的侧方距离为3.8±1.0mm。终末甲床支及骨纤维支的直径分别为0.8±0.2mm和0.7±0.1mm,趾足底固有动脉的直径为1.4±0.2mm。临床应用16例,16例皮瓣全部成活,随访时间为4~17个月,平均12个月。手指功能恢复优良,皮瓣感觉恢复分级S2-S3+,外观逼真,指甲生长外形良好,供区趾甲生长良好,趾端无疼痛,植皮无破溃发生。结论:趾足底固有动脉的终末甲床支及骨纤维支解剖恒定,设计以趾足底固有动脉—甲皱襞血管筋膜蒂为蒂的第二趾趾端复合组织串联趾侧方皮瓣进行瓦合修复指端缺损,受区外形好,供区损伤小。
[Abstract]:Objective: to explore the vascular anatomical basis and clinical application of the second toe end combined with tissue series digital lateral flap for the repair of phalanx defect. Methods: the study includes two parts: basic research and clinical application. The basic research includes cadaver. Somatic anatomy: six fresh adult lower extremities were used in this study. Among them, 4 sides were directly dissected from frozen cadavers by arterial perfusion with red latex after thawing. The proper artery of toe plantar was dissected under microscope. Using Vernier caliper to measure the position and caliber of perforating branches of the propria plantar artery of the toe. 16 cases of 16 patients with complex tissue defects of thumb and finger tips were treated with Vernier caliper. The second toe end combined tissue combined with toe lateral flap pedicled with the pedicle of Arteria propria digitorum propria digitorum nailfold vascular fascia was designed for repair. Results: the proper artery of toe sole and its terminal nail could be found in all specimens. The branches of bed and fibrous bone. The artery propria propria of toe plantar sends out the final branch of nail bed at nearly 7.6 卤0.7mm in nailfold. Bone fibrous branches were sent out in the nailfold at nearly 3.3 卤0.1mm. The lateral distance between them and the epidermis around the nail was 3.8 卤1.0 mm. the diameter of the bed branch and the fibrous branch of the end nail were 0.8 卤0.2mm and 0.7 卤0.1 mm, respectively, and the diameter of the propria plantar artery of the toe was 1.4 卤0.2 mm. The follow-up time ranged from 4 to 17 months (mean 12 months). The finger function recovered well, the skin flap sensory recovery grade was S2-S3, the appearance was lifelike, the fingernail grew well, the donor nail grew well, and the toe end had no pain. Conclusion: the final nail bed branch and bone fibrous branch of the toe plantar propria artery are constant. The second toe end combined tissue series toe lateral flap pedicled with the pedicle of the artery propria propria digitorum nailfold vascular fascia was designed to repair the defect of finger tip. The shape of the recipient area was good and the injury of donor area was small.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.2

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