摘要目的 探讨应用带神经游离环指近节皮瓣修复手指指腹缺损的手术方法及临床疗效.方法 自2012年9月至2014年1月,采用切取环指近节静脉皮瓣,皮瓣携带指固有神经背侧支和(或)指背神经,将皮瓣不倒置游离覆盖修复6例指腹缺损患者.男5例,女1例.年龄20～49岁,平均39.5岁.6例患者均为外伤导致指腹皮肤缺损伴骨外露,甲床及末节指骨无损伤.切取皮瓣面积为1.5 cm×1.5cm～2.5 cm×4.5cm,供区在前臂内侧取全厚皮片植皮.结果 术后6例患者伤口均Ⅰ期愈合,皮瓣存活良好,其中1指皮瓣术后发生静脉危象,予伤口部分拆线后逐渐缓解.6例患者术后随访6～24个月,平均12个月.患指指腹外形饱满,指间关节活动正常.指腹皮瓣感觉恢复达S3+.结论 带神经游离环指近节静脉皮瓣治疗手指指腹皮肤缺损可获得满意的功能及外形,同时重建感觉,手术操作简单,供区损伤小,是一种修复手指指腹缺损的较好方法.

abstractsObjective To investigate the surgical techniques and clinical outcomes of free transfer of proximal ring finger venous flap with sensory nerve for repair of finger pulp defect.Methods From September 2012 to January 2014,6 cases of finger pulp defect with tendon and bone exposure were treated by a venous flap harvested from the proximal ring finger with dorsal branch of the proper digital nerve or dorsal digital nerve.There were 5 males and 1 female,with an average age of 39.5 years (range,20 to 49 years).The flap size ranged from 1.5 cm × 1.5 cm to 2.5 cm × 4.5 cm.Donor site defect was covered with full thickness skin graft from the medial forearm.Results Primary wound healing was achieved in all the patients.All the flaps in this series survived eventually.Venous crisis occurred in one flap which was solved by removing some sutures to decompress.The average duration of follow-up was 12 months (range,6 to 24 months).The contour of the reconstructed pulp was full.Interphalangeal joint movement was normal.Sensation of the flaps recovered to S3 + · Conclusion Free venous flap transfer from the ring finger with a sensory nerve is an ideal procedure for repair of finger pulp defect.It restores good appearance and function,as well as sensation.It is a simple operation,without sacrificing the proper digital artery and nerve.