Yi Lankai, Xu Zhiyong, Sun Jianmin, Cao Zhenhao
Department of Hand and Foot Orthopedics, Weifang People's Hospital, Weifang Shandong, 261041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jun 15;37(6):717-720. doi: 10.7507/1002-1892.202303060.
To evaluate the effectiveness of neurovascular staghorn flap for repairing defects in fingertips.
Between August 2019 and October 2021, a total of 15 fingertips defects were repaired with neurovascular staghorn flap. There were 8 males and 7 females with an average age of 44 years (range, 28-65 years). The causes of injury included 8 cases of machine crush injury, 4 cases of heavy object crush injury, and 3 cases of cutting injury. There were 1 case of thumb, 5 cases of index finger, 6 cases of middle finger, 2 cases of ring finger, and 1 case of little finger. There were 12 cases in emergency, and 3 cases with finger tip necrosis after trauma suture. Bone and tendon exposed in all cases. The range of fingertip defect was 1.2 cm×0.8 cm to 1.8 cm×1.5 cm, and the range of skin flap was 2.0 cm×1.5 cm to 2.5 cm×2.0 cm. The donor site was sutured directly.
All flaps survived without infection or necrosis, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10 months. At last follow-up, the appearance of the flap was satisfactory, the wear resistance was good, the color was similar to the skin of the finger pulp, and there was no swelling; the two-point discrimination of the flap was 3-5 mm. One patient had linear scar contracture on the palmar side with slight limitation of flexion and extension, which had little effect on the function; the other patients had no obvious scar contracture, good flexion and extension of the fingers, and no dysfunction. The finger function was evaluated according to the total range of motion (TAM) system of the Hand Surgery Society of Chinese Medical Association, and excellent results were obtained in 13 cases and good results in 2 cases.
The neurovascular staghorn flap is a simple and reliable method to repair fingertip defect. The flap has a good fit with the wound without wasting skin. The appearance and function of the finger are satisfactory after operation.
评估吻合血管的鹿角形皮瓣修复指尖缺损的疗效。
2019年8月至2021年10月，应用吻合血管的鹿角形皮瓣修复15例指尖缺损。其中男8例，女7例，平均年龄44岁（28～65岁）。致伤原因包括机器碾压伤8例，重物挤压伤4例，切割伤3例。拇指1例，示指5例，中指6例，环指2例，小指1例。急诊手术12例，外伤缝合后指尖坏死3例。所有病例均有骨与肌腱外露。指尖缺损范围为1.2 cm×0.8 cm至1.8 cm×1.5 cm，皮瓣范围为2.0 cm×1.5 cm至2.5 cm×2.0 cm。供区直接缝合。
所有皮瓣均成活，无感染及坏死，切口一期愈合。所有患者均获随访，随访时间6～12个月，平均10个月。末次随访时，皮瓣外观满意，耐磨性能良好，颜色与指腹皮肤相近，无肿胀；皮瓣两点辨别觉为3～5 mm。1例患者手掌侧出现线状瘢痕挛缩，屈伸功能轻度受限，对功能影响较小；其余患者无明显瘢痕挛缩，手指屈伸功能良好，无功能障碍。按中华医学会手外科学会总主动活动度（TAM）系统对手指功能进行评定，优13例，良2例。
吻合血管的鹿角形皮瓣是修复指尖缺损的一种简单可靠的方法。该皮瓣与创面贴合良好，不浪费皮肤。术后手指外观及功能满意。
