摘要目的 探讨利用同指指动脉背侧支皮瓣与邻指岛状皮瓣瓦合修复手指末节套脱伤的方法与疗效.方法 我院自2012年4月至2016年8月收治20例20指机械伤致手指末节套脱伤,男16例,女4例;年龄18～59岁,平均31岁.伤后至手术时间为1～5 h,平均2.5 h.示指8例,中指6例,环指4例,小指2例.末节1/2软组织全套脱3例,末节2/3软组织全套脱12例,末节3/4软组织全套脱5例.创面缺损面积3.0 cm× 2.0 cm～5.5 cm×3.8 cm,伴轻至重度污染,肌腱与指骨外露,肌腱止点均未见断裂.采用指动脉背侧支皮瓣与邻指岛状皮瓣瓦合修复,指动脉背侧支皮瓣切取面积2.0 cm×1.5 cm～2.6 cm×2.2 cm,邻指岛状皮瓣切取面积2.5 cm×2.0 cm～3.5 cm×2.5 cm.供区均植皮修复.结果 术后发生皮瓣水泡5例,血管危象1例,对症处理后均愈合;其余皮瓣均存活.创面Ⅰ期愈合18例,Ⅱ期愈合2例.术后随访时间3～20个月,平均10.6个月.皮瓣外形饱满,质地柔软,指端无触痛.根据TAM系统评定方法评定:优17指,良2指,可1指.结论 利用同指指动脉背侧支皮瓣及邻指岛状皮瓣瓦合修复手指末节套脱伤操作简便,可自由掌控损伤,配套合理,疗效满意.

abstractsObjective To explore the surgical procedure and the clinical results of repairing distal finger degloving injury with homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap.Methods From April 2012 to August 2016,20 patients with degloving injury of the distal finger caused by machine were treated.There were 16 males and 4 females with age ranging from 18 to 59 years (mean,31 years).The time from injury to operation was 1 to 5 hours (mean,2.5 hours).Affected fingers included index finger in 8 cases,middle finger in 6 cases,ring finger in 4 cases,little finger in 2 cases.The totally degloving range was 1/2 distal finger in 3 cases,2/3 in 12 cases,3/4 in 5 cases.The defect area ranged from 3.0 cm×2.0 cm to 5.5 cm×3.8 cm,with mild to severe pollution,tendons and phalanx bone exposure.No tendon insertion rupture was seen.The homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap were applied to repair the wound.The area of homodigital flap based on the dorsal branch of the digital artery ranged from 2.0 cm× 1.5 cm to 2.6 cm× 2.2 cm,and of adjacent finger island flap ranged from 2.5 cm×2.0 cm to 3.5 cm×2.5 cm.The donor sites were repaired with skin grafts.Results Postoperatively flap blister occurred in 5 cases and vascular crisis occurred in 1 case,which survived completely after symptomatic treatment.The rest of the flaps survived uneventfully.Primary healing was achieved in 18 cases,secondary healing in 2 cases.The postoperative follow-up time ranged from 3 to 20 months with an average of 10.6 months.The flaps had well-stacked shape with soft texture and no tenderness in fingertip.According to the Total Active Movement (TAM) system evaluation standard,the finger function was assessed excellent in 17 cases,good in 2 cases and fair in 1 case.Conclusion The combination of homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap is an easy,useful and reliable technique for reconstruction of distal finger degloving injury with satisfactory results.