Hu Ji-Chao, He Jian, Chen Jun-Bo, Bu Kai-Dong
Department of Orthopedics, the Third Affiliated Hospital of Jiaxing College, Rongjun Hospital of Zhejiang Province, Jiaxing 314002, Zhejiang, China.
Zhongguo Gu Shang. 2023 Jun 25;36(6):564-9. doi: 10.12200/j.issn.1003-0034.2023.06.012.
To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits.
From January 2016 to January 2020, a total of 14 patients , 9 males and 5 females, ages ranging from 22 to 69 years old, and with volar soft tissue defects in the middle and distal digits 2 to 4, underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint. The defect area was (2.0~2.5) cm×(1.5 ~2.0) cm. The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint. Flap design, dissection of blood vessels and nerves, and anastomosis with the digital artery and nerve were performed according to a standardized protocol., Functional exercise of affected finger was initiated 3 weeks postoperatively. Subsequent assessments were conducted to evaluate finger pulp sensation, shape and other relevant parameters. According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association, the surgical outcomes were evaluated.
All 14 cases demonstrated successful tissue transplantation, , with immediate recovery of sensation observed in 10 cases with distal finger pulp defects. Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively. Thirteen patients were followed up for a mean duration of (8.8 ± 4.49) months, during which satisfactory outcomes were observed. The average two-point resolution of the finger pulp was 4-6mm, and sensory function evaluation yielded a score of S3 or above. Patients exhibited realistic finger shape, normal skin color and temperature, good wear resistance, and cold resistance. Furthermore, finger joint function was essentially normal.
The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger. This technique is characterized by its simplicity, low risk, and favorable outcomes, including restored finger shape, blood supply and sensation. Moreover, high patient satisfaction was achieved.
探索一种修复中、远节指骨掌侧软组织缺损及感觉和血管修复的手术方法。
2016年1月至2020年1月，共14例患者，男9例，女5例，年龄22～69岁，2～4指中、远节指骨掌侧软组织缺损，采用掌指关节带指动脉和神经的V-Y形皮瓣进行手术重建。缺损面积为(2.0～2.5)cm×(1.5～2.0)cm。手术步骤包括从掌指关节切取带指动脉和神经的V-Y形皮瓣。按照标准化方案进行皮瓣设计、血管神经解剖及与指动脉和神经的吻合。术后3周开始患指功能锻炼。随后进行评估以评价指腹感觉、外形及其他相关参数。根据中华医学会手外科学分会制定的上肢功能评价标准对手术效果进行评价。
14例均组织移植成功，10例远节指腹缺损者术后即刻感觉恢复。4例中节指骨缺损者术后2～3个月感觉逐渐恢复。13例患者平均随访(8.8±4.49)个月，期间效果满意。指腹平均两点分辨觉为4～6mm，感觉功能评价得分为S3及以上。患者手指外形逼真，皮肤颜色及温度正常，耐磨性及抗寒性良好。此外，手指关节功能基本正常。
掌指关节带指动脉和神经的V-Y形皮瓣为修复中、远节指骨缺损提供了一种合适的方法。该技术具有操作简单、风险低、效果良好的特点，包括恢复手指外形、血供及感觉。而且患者满意度高。
