摘要目的 探讨应用指掌侧固有动脉终末背侧皮支血管为蒂的螺旋桨皮瓣修复指端缺损的可行性与疗效.方法 2013年9月-2016年9月,应用指掌侧固有动脉终末背侧皮支为蒂的螺旋桨皮瓣修复指端缺损25例,其中男18例,女7例;年龄7.5～52.0岁,平均33岁.机器绞伤8例,电锯伤10例,重物砸伤3例,切割伤4例.其中示指13例,中指6例,环指5例,小指1例.皮瓣切取面积:小桨0.6 cm×0.4 cm～2.1 cm×0.4 cm;大桨3.0 cm×1.3 cm～5.5 cm ×2.0 cm.供区直接缝合16例,植皮修复9例.结果 术后23例全部成活,1例皮瓣远端浅层坏死,经伤口换药后愈合,1例完全坏死再次行皮瓣修复.供区愈合良好.患者分别于术后1、3和6个月复查,测量皮瓣的两点分辨觉和患指的屈伸活动度.术后25例均获随访,随访时间7～29个月,平均11.5个月.术后指端外形良好,皮瓣质地接近正常;23例两点分辨觉为6～10 mm(平均为6.5 mm),2例恢复保护性感觉.手指屈伸功能恢复良好,根据手指关节总活动度TAM系统评定:优20指,良4指,可1指,优良率96％.结论 指掌侧固有动脉终末背侧皮支血管为蒂的螺旋桨皮瓣修复指端缺损术后指体外观与功能恢复良好,且具有供区损伤小、皮支解剖恒定、切取方便等优点,是修复指端缺损的有效方法.

abstractsObjective To investigate the feasibility and efficacy of using the propeller flaps based on the terminal dorsal branch of proper palmar digital arteries for fingertip reconstruction.Methods From September,2013 to September,2016,25 fingers (25 patients) underwent fingertip reconstruction by using propeller flaps pedicled with the terminal dorsal branch of digital arteries.There were 18 males and 7 females with mean age of 33 years.The injured fingers requiring reconstruction included 13 index,6 middle,5 ring and 1 little fingers.The size of the propeller flaps:small paddles were 0.6 cm×0.4 cm-2.1 cm×0.4 cm;big paddles were 3.0 cm×1.3 cm-5.5 cm ×2.0 cm.The donor sites were closed directly in 16 cases,and skin graft appiled in 9 cases.Results Twenty-three cases fingertip defects were successfully reconstructed with this flap.One case of flap necrosis occurred,requiring secondary revision using a cross-finger flap.Donor sites healed without any complication.The mean follow-up period was 11.5 months (range:7-29 months).Fingers restored good shape and function.At 6 months after surgery,the 2-point discrimination value was 6.5 mm (range,6-10 mm).In 2 cases,protective sensation was successfully restored.The postoperative extension and flexion function was evaluated by the total active movement (TAM) system of finger joints:excellent in 20 fingers,good in 4 fingers and fair in 1 finger.The excellent and good rate was 96％.Conclusion The propeller flap based on the terminal dorsal branch of the proper palmar digital arteries to repair fingertip defect has advantages of achieving good function,appearance and minimized damage to the donor site,which is a effective method in reconstructing the fingertip defect.