攜帶神經的指固有動脈背側皮支血管鏈皮瓣修復指端缺損臨床研究
發(fā)布時間：2018-09-09 12:16
【摘要】：目的 探討攜帶神經的指固有動脈背側皮支血管鏈皮瓣修復指端缺損的效果。方法收集2013年1月-2015年3月之間就診于解放軍第371醫(yī)院顯微外科的手指指端缺損共計53例患者的臨床資料。其中應用攜帶神經的指固有動脈背側皮支血管鏈皮瓣修復指端缺損患者13例14指、應用隨意腹部皮瓣修復指端缺損患者10例、應用游離拇甲瓣修復指端缺損患者5例、應用手外傷V-Y推進皮瓣修復指端缺損患者12例,應用指固有動脈逆行島狀皮瓣修復指端缺損患者共計13例。在13例攜帶神經的指固有動脈背側皮支血管鏈皮瓣修復指端缺損患者中,男性9例,女性4例,年齡在19歲一60歲之間,平均年齡39.1歲。致傷原因：擠壓傷5例,電鋸切割傷6例,人咬傷2例。8例為指腹軟組織及部分骨質缺損；5例為手指末節(jié)指端完全缺損。該皮瓣在拇指設計為：以拇指近節(jié)中段及以遠的背側皮支為蒂,在食指、中指、環(huán)指、小指設計為患指中節(jié)中段及遠側指間關節(jié)背側皮支為蒂,依據(jù)患指缺損面積切取相應大小皮瓣。皮瓣面積最大3.8×2.5cm,最小2.2×1.2cm,13例指固有動脈背側皮支血管鏈皮瓣與13例指固有動脈逆行島狀皮瓣,均施行指固有神經背側支,與指端創(chuàng)面指固有神經殘端神經外膜吻合。于手術后12天,拆除縫線后即行功能鍛煉。根據(jù)設計要求,對納入統(tǒng)計的患者全部進行隨訪,共53例患者,隨訪內容包括皮瓣的外形、色澤、質地、出汗情況,及痛、觸覺、兩點辨別覺(2 points discrimination 2PD)、綜合質地覺及手指屈伸功能總主動活動度(Total active motion TAM)等,依不同手術方式對手術時間及費用、術后指腹綜合質地感覺、手指總主動活動度(TAM)、皮膚感覺恢復情況、綜合滿意度、皮瓣兩點辨別覺(2PD)進行比較。結果 術后53例皮瓣全部成活,隨訪1年至1年半,平均15.8個月。所有納入統(tǒng)計的病例,均以最后一次復查為準,攜帶神經的指固有動脈背側皮支血管鏈皮瓣組、游離拇甲瓣組、指固有動脈逆行島狀皮瓣組修復創(chuàng)面后在皮膚色澤、質地、外形上獲得滿意效果,指腹綜合質地感覺優(yōu)于隨意腹部皮瓣組和手外傷V-Y推進皮瓣組(P0.05)；在皮瓣感覺恢復情況和綜合滿意度方面,攜帶神經的指固有動脈背側皮支血管鏈皮瓣組優(yōu)于其他四組(P0.05)；在手指皮瓣兩點辨別覺(2PD)方面,攜帶神經的指固有動脈背側皮支血管鏈皮瓣組優(yōu)于隨意腹部皮瓣組、手外傷V-Y推進皮瓣組和游離拇甲瓣組(P0.05),而與指固有動脈逆行島狀皮瓣組之間差異無統(tǒng)計學意義(P0.05)。結論 攜帶神經的指固有動脈背側皮支血管鏈皮瓣修復指端缺損后在綜合質地感覺、感覺恢復情況、綜合滿意度、兩點辨別覺等方面具有優(yōu)勢,是一種理想的修復指端缺損手術方式。
[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.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R658.2
本文編號：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.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R658.2
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