Porto Alegre, Brazil From the Service of Hand Surgery and Reconstructive Microsurgery, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul.
Plast Reconstr Surg. 2009 Dec;124(6):2012-2018. doi: 10.1097/PRS.0b013e3181bcf2b9.
This study compares two therapies for the reconstruction of digital pulp: direct and reverse flow island flaps. Discriminatory sensation and loss of active range of motion were analyzed, with random allocation of nerve suturing.
The authors conducted a randomized prospective study of 122 patients with loss of digital pulp substance in one finger between 1995 and 2005. Patients were divided into two groups: direct flow island flap (n = 62) and reverse flow island flap (n = 60). The main outcomes were the capacity to discriminate between two points, and proximal and distal interphalangeal joint motion loss.
In the direct flap group, there was no loss of articular mobility in 51 percent of patients in the proximal interphalangeal joint and in 55 percent of patients in the distal interphalangeal joint. The reverse flap group showed no loss of articular mobility of the proximal interphalangeal joint in 85 percent of patients and of distal interphalangeal joint in 82 percent. Maximum amplitude losses of 10 and 15 degrees were observed only in the direct flap group in proximal interphalangeal joint articulation (p < 0.001), and of 10 degrees in 10 percent of patients in distal interphalangeal joint articulation (p < 0.002). All patients (n = 29) with suturing showed a Weber score less than or equal to 8, whereas only four (13 percent) of those without suturing had a score of 8; the rest had higher Weber scores (p < 0.001).
The direct island flap resulted in motion loss in both articulations of the finger but with better discriminatory sensation in comparison with the reverse flap.
本研究比较了两种用于重建指腹的治疗方法：直接和逆行岛状皮瓣。通过神经缝合的随机分配，分析了辨别感觉和主动活动范围的丧失。
作者于 1995 年至 2005 年间对 122 例单个手指指腹缺损的患者进行了一项随机前瞻性研究。患者分为两组：直接皮瓣组（n = 62）和逆行皮瓣组（n = 60）。主要结果是两点辨别能力和近侧指间关节和远侧指间关节运动丧失。
在直接皮瓣组，51%的患者近侧指间关节和 55%的患者远侧指间关节无关节活动丧失。逆行皮瓣组，85%的患者近侧指间关节和 82%的患者远侧指间关节无关节活动丧失。只有在直接皮瓣组，近端指间关节活动度的最大丧失幅度为 10 和 15 度（p < 0.001），而在远侧指间关节活动度中，10%的患者丧失 10 度（p < 0.002）。所有接受缝合的患者（n = 29）的 Weber 评分均小于或等于 8，而未接受缝合的患者中仅有 4 例（13%）的 Weber 评分为 8；其余患者的 Weber 评分更高（p < 0.001）。
与逆行皮瓣相比，直接皮瓣虽然导致手指两个关节的运动丧失，但具有更好的辨别感觉。
