Jiang Qiting, Feng Mingsheng, Jiang Zhiwei, Liu Jinzhu
Department of Hand Surgery, Zichen Hand Surgery Hospital of Chaohu City, Chaohu Anhui, 238000, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Jul;26(7):806-9.
To study the methods and effectiveness of repairing degloving injury of the distal phalanx with homodigital bilobed flaps tiled.
Between April 2008 and June 2011, 40 patients (40 fingers) with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years (mean, 30 years). The time from injury to operation was 1-5 hours (mean, 2.5 hours). Affected fingers included index in 13 cases, middle finger in 11 cases, ring finger in 9 cases, and little finger in 7 cases. The defect area ranged from 3.0 cm x 2.0 cm to 5.5 cm x 3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arterilization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm x 1.5 cm to 2.6 cm x 2.2 cm and the area of the next leaf flaps ranged from 2.5 cm x 2.0 cm to 3.5 cm x 2.5 cm. The donor sites were covered with free flaps.
Flap blister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975, the results were excellent in 27 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 96.7%.
The homodigital bilobed flaps tiled for degloving injury of the distal phalanx is simple and easy-to-operate with less injury.
探讨采用同指双叶瓦合皮瓣修复末节指骨脱套伤的方法及疗效。
2008年4月至2011年6月，收治40例（40指）因机器伤导致的末节指骨脱套伤患者，其中男30例，女10例，年龄18～56岁，平均30岁。受伤至手术时间为1～5小时，平均2.5小时。患指示指13例，中指11例，环指9例，小指7例。缺损面积为3.0 cm×2.0 cm至5.5 cm×3.8 cm。所有病例均合并肌腱及指骨外露污染，5例合并指骨骨折，肌腱止点无断裂。采用指动脉岛状皮瓣的终末背支与指动脉岛状皮瓣14例，指动脉岛状皮瓣的终末背支与指动脉岛状皮瓣的近侧背支18例，指动脉岛状皮瓣的终末背支与掌侧指浅静脉动脉化岛状皮瓣8例。上叶皮瓣面积为2.0 cm×1.5 cm至2.6 cm×2.2 cm，下叶皮瓣面积为2.5 cm×2.0 cm至3.5 cm×2.5 cm。供区采用游离皮片覆盖。
皮瓣出现水泡13例，血管危象3例。40例皮瓣全部成活，38例伤口一期愈合，2例二期愈合。供区植皮成活。术后对30例患者进行随访，随访时间8～20个月，平均10.6个月。皮瓣外观及质地满意，指尖无触痛。皮瓣感觉功能于术后4～6周恢复；12～15个月时24个皮瓣两点辨别觉为6.0～10.0 mm。按照1975年美国手外科学会推荐的总主动活动度（TAM）评价系统，优27例，良2例，可1例，优良率为96.7%。
采用同指双叶瓦合皮瓣修复末节指骨脱套伤操作简便，损伤小。
