Wang H, Yang X X, Wang B, Huo Y X, Chang H, Yang S H, Li J R
Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China.
College of Traditional Chinese Medicine, North China University of Science Technology, Tangshan 063000, China.
Zhonghua Shao Shang Za Zhi. 2020 Nov 20;36(11):1065-1069. doi: 10.3760/cma.j.cn501120-20191113-00427.
To explore the effect of venous anastomosis of the pedicled digital artery dorsal branch island flap in repairing fingertip or pulp defects of the same finger. From February 2016 to September 2018, a total of 56 emergency cases (67 fingers) with fingertip or pulp defects in 2-5 fingers were admitted to the Second Hospital of Tangshan (hereinafter referred to as the author's affiliation), and the prospective research was conducted. The patients were divided into venous anastomosis group of 29 cases (35 fingers) and non-venous anastomosis group of 27 cases (32 fingers) by drawing lots. There were 18 males and 11 females in venous anastomosis group, aged 17 to 62 years, with wound area of 1.6 cm×1.3 cm-3.1 cm×2.4 cm after debridement. There were 17 males and 10 females in non-venous anastomosis group, aged 20 to 59 years, with wound area of 1.7 cm×1.2 cm-3.0 cm×2.4 cm after debridement. According to the location and size of the fingertip or pulp defect of patients in the two groups, the flap was designed on the dorsum of the middle or proximal phalanx of the injured finger. During the operation, the epineurium of dorsal branch of the proper digital nerve or the dorsal digital nerve carried by the flap was anastomosed end-to-end with the stump of proper digital nerve in the wound. One or two superficial vein (s) carried by the flap was/were interrupted end-to-end anastomosed with the superficial veins on the dorsum or palm of the wound surface in venous anastomosis group, and the venous anastomosis was not performed in non-venous anastomosis group. The flap size resected ranged from 1.8 cm×1.5 cm to 3.4 cm×2.6 cm in venous anastomosis group, and that ranged from 1.9 cm×1.4 cm to 3.3 cm×2.6 cm in non-venous anastomosis group. The donor site wounds in the two groups were resurfaced by free full-thickness skin graft harvested from the proximal forearm or the medial side of the upper arm. The blood circulation of the flap of patients in 2 groups was observed after operation. During follow-up after operation, the patients' satisfaction for the appearance of the flap was evaluated by Michigan Hand Function Questionnaire, the flap color was observed by the chief physician of the Department of Hand Surgery in the author's affiliation, and the incidence of flap pigmentation was calculated. Data were statistically analyzed with test and chi-square test. All the flaps of patients survived without tension blister in venous anastomosis group after operation. Tension blisters occurred in 6 cases (6 fingers) in non-venous anastomosis group due to venous reflux obstruction, and the flaps survived after removing some sutures of the pedicle and changing dressing. During follow-up of 8-20 months, with an average of 15 months, the patients' satisfaction score for flap appearance in venous anastomosis group was (4.6±0.5) points, which was obviously higher than (4.3±0.6) points of non-venous anastomosis group (=2.482, <0.05). The incidence of flap pigmentation in venous anastomosis group was 9% (3/35), which was significantly lower than 31% (10/32) of non-venous anastomosis group ((2)=5.498, <0.05). The pedicled digital artery dorsal branch island flap with venous anastomosis repairs the same fingertip or pulp defects, resulting in unobstructed venous reflux, low incidence of flap pigmentation, good appearance and high patient satisfaction.
探讨带蒂指动脉背侧支岛状皮瓣静脉吻合在修复同指指尖或指腹缺损中的作用。2016年2月至2018年9月，唐山市第二医院（以下简称笔者所在单位）共收治2 - 5指指尖或指腹缺损急诊病例56例（67指），进行前瞻性研究。通过抽签将患者分为静脉吻合组29例（35指）和非静脉吻合组27例（32指）。静脉吻合组男18例，女11例，年龄17～62岁，清创后创面面积为1.6 cm×1.3 cm - 3.1 cm×2.4 cm。非静脉吻合组男17例，女10例，年龄20～59岁，清创后创面面积为1.7 cm×1.2 cm - 3.0 cm×2.4 cm。根据两组患者指尖或指腹缺损的部位及大小，在伤指中节或近节指背设计皮瓣。术中将指固有神经背侧支或皮瓣携带的指背神经的神经外膜与创面内指固有神经残端行端端吻合。静脉吻合组将皮瓣携带的1条或2条浅静脉与创面背侧或掌侧的浅静脉行端端间断吻合，非静脉吻合组不进行静脉吻合。静脉吻合组切取皮瓣大小为1.8 cm×1.5 cm～3.4 cm×2.6 cm，非静脉吻合组为1.9 cm×1.4 cm～3.3 cm×2.6 cm。两组供区创面均采用取自前臂近端或上臂内侧的游离全厚皮片覆盖。术后观察两组患者皮瓣的血液循环情况。术后随访期间，采用密歇根手功能问卷对患者皮瓣外观满意度进行评价，由笔者所在单位手外科主任医师观察皮瓣颜色，并计算皮瓣色素沉着发生率。数据采用t检验和卡方检验进行统计学分析。静脉吻合组术后所有皮瓣均成活，无张力性水疱形成。非静脉吻合组因静脉回流受阻有6例（6指）出现张力性水疱，拆除部分蒂部缝线及换药后皮瓣成活。随访8～20个月，平均15个月，静脉吻合组患者皮瓣外观满意度评分为（4.6±0.5）分，明显高于非静脉吻合组的（4.3±0.6）分（t = 2.482，P <0.05）。静脉吻合组皮瓣色素沉着发生率为9%（3/35），明显低于非静脉吻合组的31%（10/32）（χ² = 5.498，P <0.05）。带静脉吻合的带蒂指动脉背侧支岛状皮瓣修复同指指尖或指腹缺损，静脉回流通畅，皮瓣色素沉着发生率低，外观良好，患者满意度高。
