文章摘要
俞诗威,周少怀,方红育,等.带神经的指固有动脉背侧支皮瓣修复手指瘢痕挛缩屈曲畸形.骨科,2024,15(3): 248-252.
带神经的指固有动脉背侧支皮瓣修复手指瘢痕挛缩屈曲畸形
Dorsal Branch of Digital Artery with Dorsal Branch of Proper Digital Nerve in the Treatment of Scar Flexion Contractures of Fingers
投稿时间:2024-01-08  
DOI:10.3969/j.issn.1674-8573.2024.03.010
中文关键词: 皮瓣    瘢痕挛缩  屈曲畸形  指固有神经  矫形
英文关键词: Flag  Finger  Scar contracture  Flexion deformity  Proper digital nerves  Orthopedics
基金项目:
作者单位E-mail
俞诗威 武汉市第三医院骨科武汉 430060 741584671@qq.com 
周少怀 武汉市第三医院骨科武汉 430060  
方红育 武汉市第三医院骨科武汉 430060  
范明宇 武汉市第三医院骨科武汉 430060  
卞峰 武汉市第三医院骨科武汉 430060  
汪平 武汉市第三医院骨科武汉 430060  
王欣 武汉市第三医院骨科武汉 430060  
李宏亮 武汉市第三医院骨科武汉 430060  
黄涛 武汉市第三医院骨科武汉 430060  
张臣鸣 武汉市第三医院骨科武汉 430060  
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中文摘要:
      目的 探讨带神经的指固有动脉背侧支皮瓣治疗手指瘢痕挛缩屈曲畸形的临床疗效。方法 回顾性分析我院2016年4月至2020年5月收治的12例(12指)手指瘢痕挛缩屈曲畸形病人的临床资料。男7例,女5例;年龄12~34岁,平均20.4岁。烧伤7例,碾压伤4例,绞伤1例。示指5指,中指3指,环指3指,小指1指。患指屈曲畸形程度按照McCauley对指间关节屈曲畸形分类,Ⅲ型10例,Ⅳ型2例。术中彻底松解手指瘢痕挛缩矫正屈曲畸形后皮肤缺损面积为2.8 cm×2.5 cm~3.9 cm×3.0 cm,采用带神经的指固有动脉背侧支皮瓣移植修复皮肤缺损,供区采用中厚皮片移植修复。术后定期门诊随访观察皮瓣质地、外观、感觉恢复情况,根据中华医学会手外科学会上肢部分功能评定试用标准对手指功能进行评价。结果 12例(12指)手术顺利完成,皮瓣及供区移植皮片全部存活。1例术后皮瓣出现瘀紫、皮缘少许坏死,延期愈合。术后平均随访14.6个月(13~17个月),皮瓣外观良好、质地柔软、无臃肿。皮瓣两点分辨觉达4~8 mm,平均5.7 mm,3例出现异位感觉定位现象。根据中华医学会手外科学会上肢部分功能评定试用标准评定:优4例,良7例,可1例,优良率为91.7%;患指屈曲畸形矫正,主动伸屈功能得到改善,未再次出现瘢痕挛缩及屈曲畸形。结论 应用带神经的指固有动脉背侧支皮瓣修复松解瘢痕后软组织缺损,携带神经可重建感觉功能,操作简单,安全可靠,术后手指功能及外观明显改善,是一种有效修复手指瘢痕挛缩屈曲畸形的手术方法。
英文摘要:
      Objective To explore the clinical efficacy of the dorsal branch of the digital artery with the dorsal branch of the proper digital nerve in the treatment of scar flexion contractures of fingers. Methods A retrospective analysis was performed on the clinical data of 12 patients (12 fingers) with finger scar contracture and flexion deformity admitted to our hospital from April 2016 to May 2020. There were 7 males and 5 females, aged from 12 to 34 years old (mean 20.4 years old). There were 7 cases of burn, 4 cases of crush and 1 case of strangulation. There were 5 index fingers, 3 middle fingers, 3 ring fingers, and 1 little finger. The degree of flexion deformity in all patients was classified according to McCauley's classification of interphalangeal flexion deformity, including 10 cases of type Ⅲ and 2 cases of type Ⅳ. The skin defect was 2.8 cm×2.5 cm-3.9 cm×3.0 cm after the correction of flexion deformity by completely loosening the finger scar contracture during the operation. The skin defect was repaired by the dorsal branch of the digital artery with the dorsal branch of the proper digital nerve, and the donor area was repaired by medium-thickness skin graft. The skin flap texture, appearance, feeling and hand activity recovery were observed by regular outpatient follow-up after operation. The finger function was evaluated according to the trial criteria of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society. Results The operation was successful in 12 cases, and all the skin grafts in the skin flap donor area survived. In 1 case, the skin flap showed bruising and a little necrosis of the skin margin, and the healing was delayed. The average follow-up time was 14.6 months (range: 13-17 months). The flap had good appearance, soft texture and no bloated. The two-point resolution of the flap was 4-8 mm, with an average of 5.7 mm. There were 3 cases of ectopic sensory localization. According to the trial criteria of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, 4 cases were excellent, 7 cases were good, and 1 case was fair. Excellent and good rate was 91.7%. The flexion deformity of the affected finger was corrected, the active extension and flexion function was improved, and no scar contracture and flexion deformity occurred again. Conclusion The application of the dorsal branch of the digital artery with the dorsal branch of the proper digital nerve to repair the soft tissue defect after the release of the scar, carrying the nerve can reconstruct the sensory loss of the affected finger, the operation is simple, safe and reliable, and the function and appearance of the finger are significantly improved after surgery. It is the effective surgical method for the treatment of finger scar contracture flexion deformity.
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