Department of Operation Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China.
J Orthop Surg Res. 2024 Feb 3;19(1):118. doi: 10.1186/s13018-024-04608-z.
The reconstruction of medium-sized soft tissue defects of the fingertip remains a challenge for hand surgeons. The aim of this study was to compare the outcomes of modified triangular neurovascular unilateral advancement flap and digital artery dorsal perforator flap in the treatment of this injury.
From May 2018 to May 2022, 70 patients with medium-sized volar soft tissue defects were enrolled. The patients were divided into two groups based on the flap type: modified triangular neurovascular unilateral advancement flap (Group A) and digital artery dorsal perforator flap (Group B). The debridement times, defect size, operation time, and flap survival rate were recorded. At follow-up, hand function, aesthetics, and complications were evaluated. Function was evaluated using the TAM score. The aesthetics of the reconstructed and donor sites were assessed using the vancouver scar scale (VSS). The static two-point discrimination of the finger pulp served as a measure of tactile agnosia.
A total of 10 patients were lost to follow-up for various reasons, resulting in 30 cases remaining in each group. The general information of the two groups showed no significant differences in age, sex, injury side, cause of injury, time from injury to surgery, and operation time (P > 0.05). Additionally, the debridement times and size of the defect were similar between the groups (P > 0.05). However, the operation time was significantly shorter in Group A compared to Group B (P = 0.001). With regard to complications, there was no significant difference between them. At one-month follow-up, TAM scores indicated that Group B performed significantly better than Group A. However, at the final follow-up period, there was no significant difference in TAM scores between the two groups. When considering the VSS, significant differences were observed between the two groups in both the reconstructed site and donor site.
Both flaps can effectively repair medium-sized fingertip defects. Furthermore, the modified triangular neurovascular unilateral advancement flap offers anatomical reconstruction possibilities, ensuring satisfactory sensation and cosmetic contour.
指尖中型软组织缺损的重建仍然是手外科医生面临的挑战。本研究旨在比较改良三角血管神经单侧推进皮瓣和指动脉背侧穿支皮瓣治疗这种损伤的效果。
2018 年 5 月至 2022 年 5 月，纳入 70 例中型掌侧软组织缺损患者。根据皮瓣类型将患者分为两组：改良三角血管神经单侧推进皮瓣（A 组）和指动脉背侧穿支皮瓣（B 组）。记录清创时间、缺损大小、手术时间和皮瓣成活率。随访时评估手功能、美观和并发症。功能采用 TAM 评分评估，重建和供区的美学采用温哥华瘢痕量表（VSS）评估，手指腹的静态两点辨别觉作为触觉丧失的测量。
共有 10 例患者因各种原因失访，每组各有 30 例。两组患者的一般资料在年龄、性别、损伤侧、损伤原因、受伤至手术时间和手术时间方面差异无统计学意义（P>0.05）。此外，两组的清创时间和缺损大小相似（P>0.05）。但 A 组的手术时间明显短于 B 组（P=0.001）。关于并发症，两组之间没有显著差异。在 1 个月随访时，B 组的 TAM 评分明显高于 A 组。然而，在最终随访时，两组之间的 TAM 评分无显著差异。在 VSS 方面，两组在重建部位和供区部位均有显著差异。
两种皮瓣均可有效修复中型指尖缺损。此外，改良三角血管神经单侧推进皮瓣具有解剖重建的可能性，可确保满意的感觉和美容轮廓。
