Qin Hongjiu, Xia Jiang, Hu Bin, Wang Haisheng, Xu Lei, Wang Yinze
Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical Collage, Wuhu Anhui, 241001, P.R.China.
Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical Collage, Wuhu Anhui, 241001,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jul 15;31(7):841-844. doi: 10.7507/1002-1892.201703053.
To investigate the operative method of repairing soft tissue defect of the thumb with modified radial dorsal fasciocutaneous flap and its effectiveness.
Between June 2015 and December 2016, 15 patients with volar or dorsal defects of the thumb were treated with modified radial dorsal fasciocutaneous flaps which distal pedicles were cut off. Of 15 cases, 11 were male and 4 were female, aged 35-70 years (mean, 46 years). The causes of injury included crush injury in 12 cases and avulsion injury in 3 cases. Because all patients had volar or dorsal defects of the thumb which were accompanied by tendon or bone exposure, they had no condition or desire to replant. There were 12 cases of volar defect of thumb and 3 cases of dorsal defect. The area of defects ranged from 2.0 cm×1.2 cm to 3.0 cm×2.5 cm. The time between injury and operation was 16 hours to 2 days (mean, 30.4 hours). The radial dorsal fascio-cutaneous flaps of 2.3 cm×1.5 cm to 3.3 cm×2.8 cm in size were adopted to repair defects. The donor sites were directly sutured.
All flaps survived, and no severe swelling or tension blister occurred. The donor sites and wounds healed by first intention. All patients were followed up 3-12 months (mean, 6 months). The color and texture of the grafted flaps were similar to those of normal skin, with no bloated appearance. According to total active motion standard at last follow-up, the finger function was excellent in 8 cases and good in 7 cases.
Modified radial dorsal fasciocutaneous flap of the thumb is a reliable flap with easy dissection and less trauma in repair of soft tissue defects of the thumbs, and satisfactory clinical outcome can be obtained.
探讨采用改良桡背侧筋膜皮瓣修复拇指软组织缺损的手术方法及其疗效。
2015年6月至2016年12月，对15例拇指掌侧或背侧缺损患者采用切断远端蒂的改良桡背侧筋膜皮瓣进行治疗。15例中，男11例，女4例，年龄35 - 70岁（平均46岁）。致伤原因：挤压伤12例，撕脱伤3例。所有患者均存在拇指掌侧或背侧缺损并伴有肌腱或骨质外露，均无条件或意愿进行再植。拇指掌侧缺损12例，背侧缺损3例。缺损面积为2.0 cm×1.2 cm至3.0 cm×2.5 cm。受伤至手术时间为16小时至2天（平均30.4小时）。采用大小为2.3 cm×1.5 cm至3.3 cm×2.8 cm的桡背侧筋膜皮瓣修复缺损，供区直接缝合。
所有皮瓣均成活，未出现严重肿胀或张力性水疱。供区及创面均一期愈合。所有患者均获随访3 - 12个月（平均6个月）。移植皮瓣颜色、质地与正常皮肤相近，无臃肿外观。末次随访时按总主动活动度标准，手指功能优8例，良7例。
改良拇指桡背侧筋膜皮瓣是修复拇指软组织缺损的一种可靠皮瓣，解剖操作简便，创伤小，临床效果满意。
