摘要目的 比较指掌侧固有动脉背侧支逆行岛状皮瓣瓦合邻指皮瓣与传统的腹部皮瓣修复手指脱套伤的临床疗效及手术难度.方法 纳入标准:①软组织缺损平面在患指远指间关节水平.②第2～5指损伤.③单指脱套伤.④受伤时间少于8h.排除标准:①合并骨折或肌腱损伤.②损伤累及多指.③随访时间在6个月以内.收集2009年2月-2016年9月间收治手指脱套伤患者,共52例52指纳入研究,其中男32例,女20例,年龄18～60岁,平均(36.02±11.00)岁.伤后至手术开始时间为2.5～8.0 h,平均(4.81±1.28)h.伤指指别:示指15例,中指22例,环指10例,小指5例.其中20例20指采用患指指掌侧固有动脉背侧支逆行岛状皮瓣瓦合邻指皮瓣修复(瓦合皮瓣组),供区取前臂全厚皮片打包游离移植,2～3周后行手术断蒂;32例32指采用传统的腹部皮瓣方法修复(腹部皮瓣组),3～5周后行手术断蒂.结果 术后52例均获得随访,随访时间6～25个月,平均(9.25±3.97)个月.两组手术时间:瓦合皮瓣组为(98.46±8.34)min,腹部皮瓣组为(107.84±8.63)min,两组术式的手术时间差异无统计学意义(P＜0.05);两组断蒂时间:瓦合皮瓣组为(16.75±1.74)d,腹部皮瓣组为(28.31±5.12)d,差异有统计学意义(P＜0.05),瓦合皮瓣组的断蒂时间明显少于腹部皮瓣组;两组末次随访皮瓣功能的评定:瓦合皮瓣组优良率90.00％,腹部皮瓣组优良率59.38％,差异有统计学意义(P＜0.05),瓦合皮瓣组明显优于腹部皮瓣组;末次随访患指功能的评定:瓦合皮瓣组优良率95.00％,腹部皮瓣组优良率71.88％,差异有统计学意义(P＜0.05),瓦合皮瓣组明显优于腹部皮瓣组.结论 指掌侧固有动脉背侧支皮瓣瓦合邻指皮瓣修复手指远节脱套伤是手术操作简单、安全可靠,术后患指外观和功能等修复效果满意,明显优于传统的腹部皮瓣.

abstractsObjective To compare the clinical effect and operation difficulty of the combined skin flap with reversed proper palmar digital arterial dorsal branch island flap and cross-finger flap and the abdominal flap in the treatment of distal finger degloving injury.Methods Inclusion criteria:①Soft tissue defect far beyond the level of distal interphalangeal joints.②The inured finger was from second to fifth.③Single finger injury.④ Iniury time within 8 h.Exclusive criteria:①With tendon injury.② Multiple finger injuries.③Followed-up time within 6 months.Between February,2009 and September,2016,52 patients (52 fingers) with distal finger degloving injury were reviewed,there were 32 males and 20 females,aged from 18 to 60 (36.02±11.00) years.The time from injury to operation was 2.5-8.0 (4.81±1.28) h.Affected fingers included index finger in 15 cases,middle finger in 22 cases,ring finger in 10 cases,and little finger in 5 cases.Twenty patients (20 fingers) were treated by combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap(group combined-flap).The cubital skin was grafted onto the donor sites.Thirty-two patients (32 fingers) were treated by abdominal flap (group abdominal-flap).Results The patients were followed-up 6-25 (9.25±3.97) months.The operation time:group combined-flap was 80-130 (98.46±8.34) min and group abdominal-flap was 85-125(107.84±8.63)min.There was no significant difference in two groups (P＞0.05).Pedicle division time:group combined-flap was 15-24 (16.75±1.74) d and group abdominal-flap was 24-45 (28.31±5.12) d.There was a significant difference in two groups (P＜0.05).And the pedicle division time in group combined-flap was much shorter than in group abdominal-flap.Flap function at last follow-up,the excellent and good rate of the flap in group combined-flap and group abdominal-flap was 90.00％ and 59.38％,respectively.There was a significant difference in two groups (P＜0.05),and the flap function in group combined-flap was much better than in group abdominal-flap.Affected finger function at last follow-up,the excellent and good rate of the affected fingers was 95.00％ and 71.88％.There was a significant difference in two groups (P＜0.05),and the affected finger function in group combined-flap was much better than in group abdominal-flap.Conclusion The combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap is a simple and high-survival-rate flap,whose texture,appearance and clinical outcome for repair of distal finger degloving injury are much better than traditional abdominal flap.