Zhou Xiao, Xu Yajun, Rui Yongjun, Shou Kuishui, Yao Qun
Department of Hand Surgery, Wuxi Hand Surgery Hospital, Wuxi Jiangsu 214062, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Sep;25(9):1036-9.
To investigate the effectiveness of the island flap pedicled with the dorsal cutaneous branches of thumb radial digital artery from the same finger for repairing pulp defect.
Between June 2009 and March 2010, 10 patients (10 fingers) with pulp defect of thumb were treated. There were 6 males and 4 females, aged 13-68 years with an average of 38 years. Defect was caused by machine crush in 4 cases, by saw machine in 3 cases, by chronic infection in 2 cases, and by burn in 1 case. The disease duration was 3 hours to 4 months. In 4 cases of distal pulp defect (1.0 cm x 0.8 cm to 2.0 cm x 1.4 cm) with exposure of bone or tendon, defect was repaired with island flap pedicled with the interphalangeal joint cutaneous branches of thumb radial digital artery (1.0 cm x 0.8 cm to 2.2 cm x 1.5 cm). In 6 cases of proximal pulp defect (1.0 cm x 0.8 cm to 2.5 cm x 2.0 cm) with exposure of bone or tendon, defect was repaired with island flap pedicled with the metacarpophalangeal joint cutaneous branches of thumb radial digital artery (1.0 cm x 0.8 cm to 2.6 cm x 2.2 cm). The donor sites were repaired with skin grafts.
All flaps and skin grafts survived, and wounds healed by first intention. Ten cases were followed up 6-12 months (mean, 8 months). The colour, texture, and contour of the flaps were good. The two-point discrimination was 7-10 mm on the island flap at last follow-up. According to total active motion (TAM) standard, the thumb function was assessed as excellent in 8 cases, good in 1 case, and fair in 1 case, and the excellent and good rate was 90%.
The main digital artery and nerve of thumb will not be sacrificed when the island flap pedicled with the dorsal cutaneous branches of thumb radial digital artery is used. The operative procedure is simple, so it is a good method for repairing pulp defect of thumb.
探讨采用同一手指的拇指桡侧指固有动脉背侧皮支为蒂的岛状皮瓣修复指腹缺损的疗效。
2009年6月至2010年3月，收治10例（10指）拇指指腹缺损患者。男6例，女4例，年龄13～68岁，平均38岁。致伤原因：机器碾压伤4例，电锯伤3例，慢性感染2例，烧伤1例。病程3小时至4个月。4例远节指腹缺损（1.0 cm×0.8 cm～2.0 cm×1.4 cm），伴有骨或肌腱外露，采用拇指桡侧指固有动脉指间关节皮支为蒂的岛状皮瓣（1.0 cm×0.8 cm～2.2 cm×1.5 cm）修复；6例近节指腹缺损（1.0 cm×0.8 cm～2.5 cm×2.0 cm），伴有骨或肌腱外露，采用拇指桡侧指固有动脉掌指关节皮支为蒂的岛状皮瓣（1.0 cm×0.8 cm～2.6 cm×2.2 cm）修复。供区采用植皮修复。
所有皮瓣及植皮均成活，创面一期愈合。10例患者随访6～12个月（平均8个月），皮瓣颜色、质地、外形良好。末次随访时岛状皮瓣两点辨别觉为7～10 mm。按总主动活动度（TAM）标准评定，拇指功能优8例，良1例，可1例，优良率为90%。
采用拇指桡侧指固有动脉背侧皮支为蒂的岛状皮瓣不牺牲拇指主要的指动脉和神经，手术操作简单，是修复拇指指腹缺损的较好方法。
