目的 探讨第一掌背动脉皮瓣联合大鱼际皮瓣修复拇指末节皮肤脱套伤的疗效. 方法2009年1月至2014 年7 月,我院收治拇指末节皮肤脱套伤19 例,创面缺损面积2 cm ×5 cm~3 cm ×6 cm,其中13例合并甲床缺如,6例伴甲床残留,均采用第一掌背动脉皮瓣联合大鱼际皮瓣进行修复.观察记录患者术后拇指的外形、感觉及手指总主动活动度( total active motion, TAM) ,采用中华医学会手外科学会上肢部分功能评定试用标准评价手指功能,Michigan手外科问卷评定患者对拇指外观的满意度. 结果 本组12例皮瓣术后完全存活;5例术后2~4 d皮瓣表面出现水疱,颜色暗红,拆除蒂部旋转点缝线后,皮瓣血运逐渐好转,最终存活良好;2例第一掌背动脉皮瓣尖端皮缘坏死,换药后痂下愈合,无骨外露. 所有供区切口均一期愈合. 术后3个月随访时,手指皮瓣外形良好,指腹皮瓣感觉可,两点辨别觉6~9 mm,指背皮瓣无感觉恢复;手指功能评定结果:优17指,良2指,优良率为100%;Michigan手外科问卷评定结果:非常满意15例,满意4例. 结论 该术式疗效满意,是治疗拇指末节皮肤脱套伤的一种可行性方法.%Objective To investigate the curative effect of the first dorsal metacarpal artery flap com-bined with thenar flap to repair thumb degloving injuries. Methods From Jan. 2009 to Jul. 2014, 19 cases of distal thumb degloving injury in our hospital were collected and the defect area was between 2 cm ×5 cm-3 cm×6 cm, including 13 cases of nail bed defect, and 6 cases of nail bed residual. The first dorsal metacarpal artery skin flap and thenar flap were used to repair the skin. The shape, feel and the total active motion ( TAM) of the thumbs were observed. Finger function was assessed according to the trial criteria of upper limb functional evaluation developed by the Chinese Medical Society of Hand Surgery. The Michigan hand surgery questionnaire was used to evaluate the satisfaction of the patients. Results Twelve flaps survived completely. Five flaps had blisters 2-4 days after operation and showed dark red, and they were gradually improved after the sutures of the rotation point were removed. Two cases had the dorsal metacarpal artery flap tip skin edge necro-sis and healed after dressing change under the scab, without bone exposure. All the incisions obtained the stage I healing. At 3th month after operation, finger flaps were in good shape, the sense of the abdominal flap was fine, two-point discrimination sleep was 6-9 mm, and dorsal skin sensory recovery was satisfactory. The finger function of the patients was excellent in 17 fingers, good in 2 fingers with the excellent and good rate being 100%. The results of Michigan Hand Surgery questionnaire were as follows:very satisfactory in 15 cases, and satisfactory in 4 cases. Conclusion The therapeutic effect of this surgical treatment is satisfactory.
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