携带神经的指固有动脉背侧皮支血管链皮瓣修复指端缺损临床研究
发布时间：2018-09-09 12:16
【摘要】：目的 探讨携带神经的指固有动脉背侧皮支血管链皮瓣修复指端缺损的效果。方法收集2013年1月-2015年3月之间就诊于解放军第371医院显微外科的手指指端缺损共计53例患者的临床资料。其中应用携带神经的指固有动脉背侧皮支血管链皮瓣修复指端缺损患者13例14指、应用随意腹部皮瓣修复指端缺损患者10例、应用游离拇甲瓣修复指端缺损患者5例、应用手外伤V-Y推进皮瓣修复指端缺损患者12例,应用指固有动脉逆行岛状皮瓣修复指端缺损患者共计13例。在13例携带神经的指固有动脉背侧皮支血管链皮瓣修复指端缺损患者中,男性9例,女性4例,年龄在19岁一60岁之间,平均年龄39.1岁。致伤原因：挤压伤5例,电锯切割伤6例,人咬伤2例。8例为指腹软组织及部分骨质缺损；5例为手指末节指端完全缺损。该皮瓣在拇指设计为：以拇指近节中段及以远的背侧皮支为蒂,在食指、中指、环指、小指设计为患指中节中段及远侧指间关节背侧皮支为蒂,依据患指缺损面积切取相应大小皮瓣。皮瓣面积最大3.8×2.5cm,最小2.2×1.2cm,13例指固有动脉背侧皮支血管链皮瓣与13例指固有动脉逆行岛状皮瓣,均施行指固有神经背侧支,与指端创面指固有神经残端神经外膜吻合。于手术后12天,拆除缝线后即行功能锻炼。根据设计要求,对纳入统计的患者全部进行随访,共53例患者,随访内容包括皮瓣的外形、色泽、质地、出汗情况,及痛、触觉、两点辨别觉(2 points discrimination 2PD)、综合质地觉及手指屈伸功能总主动活动度(Total active motion TAM)等,依不同手术方式对手术时间及费用、术后指腹综合质地感觉、手指总主动活动度(TAM)、皮肤感觉恢复情况、综合满意度、皮瓣两点辨别觉(2PD)进行比较。结果 术后53例皮瓣全部成活,随访1年至1年半,平均15.8个月。所有纳入统计的病例,均以最后一次复查为准,携带神经的指固有动脉背侧皮支血管链皮瓣组、游离拇甲瓣组、指固有动脉逆行岛状皮瓣组修复创面后在皮肤色泽、质地、外形上获得满意效果,指腹综合质地感觉优于随意腹部皮瓣组和手外伤V-Y推进皮瓣组(P0.05)；在皮瓣感觉恢复情况和综合满意度方面,携带神经的指固有动脉背侧皮支血管链皮瓣组优于其他四组(P0.05)；在手指皮瓣两点辨别觉(2PD)方面,携带神经的指固有动脉背侧皮支血管链皮瓣组优于随意腹部皮瓣组、手外伤V-Y推进皮瓣组和游离拇甲瓣组(P0.05),而与指固有动脉逆行岛状皮瓣组之间差异无统计学意义(P0.05)。结论 携带神经的指固有动脉背侧皮支血管链皮瓣修复指端缺损后在综合质地感觉、感觉恢复情况、综合满意度、两点辨别觉等方面具有优势,是一种理想的修复指端缺损手术方式。
[Abstract]:Objective To investigate the effect of the dorsal cutaneous branch vascular chain flap of the proper digital artery carrying nerve in repairing fingertip defect.Methods The clinical data of 53 patients with fingertip defect were collected from January 2013 to March 2015 who were treated in microsurgery of 371 Hospital of PLA. There were 13 cases with fingertip defect, 14 fingers with free abdominal flap, 5 cases with free thumbnail flap, 12 cases with fingertip defect and 13 cases with fingertip defect. There were 9 males and 4 females with an average age of 39.1 years, ranging from 19 to 60 years old. The causes of injury were crush injury in 5 cases, electric saw cutting injury in 6 cases, human bite in 2 cases. 8 cases were soft tissue and partial bone defect of finger pulp; 5 cases were complete defect of finger tip. The flap was designed to be pedicled with the dorsal cutaneous branch of the proximal and distal segment of the thumb, and the dorsal cutaneous branch of the middle and distal interphalangeal joints of the middle segment of the affected finger and the dorsal cutaneous branch of the distal interphalangeal joints of the affected finger. The flap was designed to be 3.8 *2.5 cm in area and 2.2 *1.2 cm in area. The dorsal proper digital artery was found in 13 cases. The dorsal branch of the proper digital nerve was anastomosed with the epineurium of the remnant of the proper digital nerve at the fingertip wound. Functional exercises were performed 12 days after the operation. All the patients were followed up according to the design requirements. A total of 53 patients were followed up. The shape, color, texture, perspiration, pain, touch, 2-point discrimination 2PD, total active motion TAM, total active motion TAM, total active motion TAM of finger and pulp, total active motion TAM of finger and skin were measured according to different operation methods. Results All the 53 flaps survived from 1 year to 1 year and a half, with an average follow-up of 15.8 months. All the cases included in the statistics were based on the last reexamination. The dorsal branch of the proper digital artery with nerve was used as the flap group, the free thumbnail flap group, and the proper digital artery as the flap group. The skin color, texture and appearance of the skin in the reverse artery island flap group were satisfactory, and the comprehensive texture of the pulp of the finger was better than that of the random abdominal flap group and the V-Y push flap group (P 0.05). In the other four groups (P 0.05), the dorsal branch of the proper digital artery with nerve was superior to the random abdominal flap in the two-point discrimination of the finger flap (P 0.05), the V-Y push flap and the free thumbnail flap (P 0.05), but there was no significant difference between the two groups (P 0.05). The dorsal cutaneous branch vascular chain flap of the proper digital artery carrying nerve has advantages in comprehensive texture sensation, sensory recovery, comprehensive satisfaction and two-point discrimination. It is an ideal surgical method for repairing fingertip defect.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.2
本文编号：2232345
[Abstract]:Objective To investigate the effect of the dorsal cutaneous branch vascular chain flap of the proper digital artery carrying nerve in repairing fingertip defect.Methods The clinical data of 53 patients with fingertip defect were collected from January 2013 to March 2015 who were treated in microsurgery of 371 Hospital of PLA. There were 13 cases with fingertip defect, 14 fingers with free abdominal flap, 5 cases with free thumbnail flap, 12 cases with fingertip defect and 13 cases with fingertip defect. There were 9 males and 4 females with an average age of 39.1 years, ranging from 19 to 60 years old. The causes of injury were crush injury in 5 cases, electric saw cutting injury in 6 cases, human bite in 2 cases. 8 cases were soft tissue and partial bone defect of finger pulp; 5 cases were complete defect of finger tip. The flap was designed to be pedicled with the dorsal cutaneous branch of the proximal and distal segment of the thumb, and the dorsal cutaneous branch of the middle and distal interphalangeal joints of the middle segment of the affected finger and the dorsal cutaneous branch of the distal interphalangeal joints of the affected finger. The flap was designed to be 3.8 *2.5 cm in area and 2.2 *1.2 cm in area. The dorsal proper digital artery was found in 13 cases. The dorsal branch of the proper digital nerve was anastomosed with the epineurium of the remnant of the proper digital nerve at the fingertip wound. Functional exercises were performed 12 days after the operation. All the patients were followed up according to the design requirements. A total of 53 patients were followed up. The shape, color, texture, perspiration, pain, touch, 2-point discrimination 2PD, total active motion TAM, total active motion TAM, total active motion TAM of finger and pulp, total active motion TAM of finger and skin were measured according to different operation methods. Results All the 53 flaps survived from 1 year to 1 year and a half, with an average follow-up of 15.8 months. All the cases included in the statistics were based on the last reexamination. The dorsal branch of the proper digital artery with nerve was used as the flap group, the free thumbnail flap group, and the proper digital artery as the flap group. The skin color, texture and appearance of the skin in the reverse artery island flap group were satisfactory, and the comprehensive texture of the pulp of the finger was better than that of the random abdominal flap group and the V-Y push flap group (P 0.05). In the other four groups (P 0.05), the dorsal branch of the proper digital artery with nerve was superior to the random abdominal flap in the two-point discrimination of the finger flap (P 0.05), the V-Y push flap and the free thumbnail flap (P 0.05), but there was no significant difference between the two groups (P 0.05). The dorsal cutaneous branch vascular chain flap of the proper digital artery carrying nerve has advantages in comprehensive texture sensation, sensory recovery, comprehensive satisfaction and two-point discrimination. It is an ideal surgical method for repairing fingertip defect.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.2
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