Objective: To investigate the effectiveness of heterodigital antegrade digital artery island flap innervated by proper digital nerve and the dorsal branch of proper digital nerve for repairing digital volar complex soft tissue defects.
Methods: Between May 2014 and January 2018, 27 patients with digital volar complex soft tissue defects were treated. There were 17 males and 10 females with an average age of 37 years (range, 18-60 years). The causes included electric saw injury in 8 cases, twisted injury in 12 cases, and heavy pound injury in 7 case. There were 9 thumbs, 5 index fingers, 6 middle fingers, 3 ring fingers, and 4 little fingers. The interval between injury and admission ranged from 1 to 4 hours (mean, 2.5 hours). The defect size ranged from 2.2 cm×1.4 cm to 3.8 cm×2.3 cm. The mean length of unilateral proper digital nerve defect was 2.9 cm (range, 2-4 cm). All defects were repaired with heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve. The proper digital nerve and the dorsal branch of the proper digital nerve in the flap were anastomosed with the proper digital nerve stumps in the wound. The flap size ranged from 2.4 cm×1.6 cm to 4.1 cm×2.6 cm. A segment of dorsal branch of the proper digital nerve was intercalated into the defect of the proper digital nerve in donor site. And the defect of donor site was repaired with the full-thickness skin graft.
Results: All flaps and skin grafts survived, and the wounds healed by first intention. All patients were followed up 12-24 months (mean, 17 months). The appearance, color, and texture of the flaps were similar to the surrounding tissue. There was no pain and double sensibility in any flap. At last follow-up, the static two-point discrimination of the flaps ranged from 4 to 8 mm (mean, 5.3 mm). And the two-point discrimination of digital pulps of recipient and donor fingers ranged from 4 to 10 mm with the average of 6.2 mm and 6.0 mm, respectively. 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 18 cases and good in 9 cases. No scar contracture was observed in donor site.
Conclusion: The heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve provides a safe and simple technique with minimal donor site cost and satisfactory effectiveness, which could be an ideal option for repairing digital volar defect, especially for the defect complicated with digital nerve defect.
目的: 探讨带指固有神经及其背侧支的异指指动脉顺行岛状皮瓣修复手指掌侧复合软组织缺损的临床疗效。.
方法: 2014 年 5 月—2018 年 1 月，收治 27 例手指掌侧复合软组织缺损患者。男 17 例，女 10 例；年龄 18～60 岁，平均 37 岁。致伤原因：电锯伤 8 例，机器绞伤 12 例，重物砸伤 7 例。损伤指别：拇指 9 例，示指 5 例，中指 6 例，环指 3 例，小指 4 例。伤后至入院时间为 1～4 h，平均 2.5 h。清创后软组织缺损范围为 2.2 cm×1.4 cm～3.8 cm×2.3 cm。存在一侧指固有神经缺损，长度为 2～4 cm，平均 2.9 cm。采用带指固有神经及其背侧支的异指指动脉顺行岛状皮瓣移位修复，同时吻合创面内指固有神经断端；皮瓣切取范围为 2.4 cm×1.6 cm～4.1 cm×2.6 cm。供区取皮瓣近端指固有神经背侧支修复指固有神经缺损，并游离植皮修复。.
结果: 术后 27 例皮瓣及供区植皮均顺利成活，创面Ⅰ期愈合。患者均获随访，随访时间 12～24 个月，平均 17 个月。皮瓣外形饱满，颜色、质地与周围组织相似，无疼痛及异位感。末次随访，皮瓣静态两点辨别觉为 4～8 mm，平均 5.3 mm。伤指及供指指腹静态两点辨别觉为 4～10 mm，平均分别为 6.2 mm 及 6.0 mm。伤指功能参照中华医学会手外科学会上肢部分功能评定试用标准，获优 18 例、良 9 例。供区无明显瘢痕挛缩。.
结论: 带指固有神经及其背侧支的异指指动脉顺行岛状皮瓣修复手指掌侧软组织缺损，安全简便、供区损伤小，是一种较理想的治疗方法，尤其适用于伴一侧指固有神经缺损者。.
Keywords: Digital volar defect; digital artery flap; nerve repair; wound repair.