摘要目的 探讨手指远节套脱伤的手术方法和临床疗效.方法 自2010年1月至2014年5月共收治34例34指远节套脱伤患者,男24例,女10例;年龄21～60岁,平均35岁.伤后至手术时间为1～8h,平均4.5h.伤指指别:示指7指,中指15指,环指9指,小指3指.合并远节指骨骨折12指.皮肤软组织缺损面积约2.0 cm× 1.8 cm～3.0 cm×2.5 cm.采用改良的指固有动脉背侧支逆行岛状皮瓣(保留近指间关节背侧的皮肤,取下的皮瓣形似“骆驼的双峰”,以下简称“双峰样”皮瓣)修复远节皮肤套脱性组织缺损.供区取前臂全厚皮片游离移植.结果 8例皮瓣术后出现水泡、结痂,其中2例二期手术指端修整,其余皮瓣及植皮均顺利存活.34例随访时间6～20个月,平均9.3个月,伤指外形较满意,皮瓣质地相近、耐磨性好,指间关节功能基本正常,皮瓣两点分辨觉6.2～9.1 mm.参照中华医学会手外科学会上肢部分功能评定试用标准:优24例,良8例,可2例;优良率94.1％.结论 “双峰样”皮瓣修复手指远节套脱伤,是一种操作简便、安全、疗效满意的治疗方法.

abstractsObjective To investigate the surgical procedures and the clinical results of repairing degloving injury of the distal finger.Methods Between January 2010 and May 2014,34 patients (34 fingers)with degloving injury of the distal finger were treated.There were 24 males and 10 females with ages ranging from 21 to 60 years (mean,35 years).The time from injury to operation was 1 to 8 hours (mean,4.5 hours).Affected fingers included index finger in 7 cases,middle finger in 15 cases,ring finger in 9 cases,and little finger in 3 cases.Twelve cases were complicated with fracture of the distal phalanx.The defect area ranged from 2.0 cm× 1.8 cm to 3.0 cm×2.5 cm.Modified reverse island flap based on the dorsal branch of the digital artery was used to cover the defects of the distal finger caused by the degloving injury.The flap shaped like the humps of a camel (double hump flap).Full thickness skin graft from the forearm was used to cover the donor site.Results Blister and scabs occurred in 8 cases,and two of them were revised by second intention.The other flaps and skin grafts survived uneventfully.The patients were follow-up for 6 to 20 months (mean,9.3 months).All the flaps presented satisfactory appearance and texture,and the flexion and extension function of affected fingers nearly returned to normal.Two-point discrimination ranged from 6.2 to 9.1 mm at the last follow-up.According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association,the results were excellent in 24 cases,good in 8 cases,and fair in 2 cases,the excellent and good rate being 94.1％.Conclusion Modified reverse island flap based on the dorsal branch of the digital artery,namely the double-hump flap,is a simple and safe,easy-to-operate and effective method for treating degloving injury of the distal finger.