拇指背侧皮神经营养血管皮瓣修复对拇指远端软组织缺损的效果观察

目的:探讨拇指背侧皮神经营养血管皮瓣修复拇指远端软组织缺损的临床效果。方法:选取我院2014年1月至2016年12月收治的拇指远端软组织缺损患者100例,随机分为对照组和观察组。对照组采取腹部皮瓣对拇指远端软组织缺损进行修复,观察组采取拇指背侧皮神经营养血管皮瓣对其进行修复。通过随访患者,记录分析皮瓣的生存状况、感觉指标、外观以及手部功能的DASH评分比较两组的修复效果。结果:观察组50例患者皮瓣全部成活。对照组50例皮瓣全部成活。与对照组相比,观察组在触觉、温度觉、单丝、两点辨别觉、瘢痕挛缩方面明显优于对照组(P0.05),臃肿发生率明显低于对照组(P0.05)。观察组DASH评分为29.56±2.14分,对照组为38.13±3.12分,观察组的DASH评分明显低于对照组(P0.05)。结论:拇指背侧皮神经营养血管皮瓣修复拇指远端软组织缺损手术不破坏主要血管神经,对供区影响小,操作简单,修复的指腹感觉,拇指外形较佳,是较为理想的选择。

Clinical Efficacy of Neurocutaneous Vascular Flap in Repairing the Soft Tissue Defects of Thumb Distal with Dorsal

ABSTRACT Objective: To analyze and investigate the clinical efficacy on repairing soft tissue defects of the thumb distal with dor- sal neurocutaneous vascular flap. Methods: Select 100 cases of patients with soft tissue defects of the thumb distal from January 2014 to December 2016, who were randomly divided into two groups, the control group and observation group. Take the abdominal skin flap to repair soft tissue defects of the thumb distal in the control group, with the thumb distal with dorsal neurocutaneous vascular flap in the ob- servation group. The survival condition, the indicators of feelings, the appearance of skin flap, as well as the DASH score of the hand function have been recorded and analyzed through follow-up patients, to observe the effects on repairing soft tissue defects in the two groups. Results: All transplanted tisssues were all survived in the observation group and control group. Compared with control group, the sense of touch, temperature sense, monofilament, two-point discrimination, scar contracture of the observation group were better(P<0.05), the incidence of bloat was lower(P<0.05). The DASH scores were 29.56±2.14, 38.13±3.12 in the observation group and control group, which was significantly lower in the observation group than that of the control group(P<0.05). Conclusion: The clinical efficacy of the dorsal neurocutaneous vascular flap is better than that of abdominal skin flap on repairing soft tissue defects of the thumb distal. For no injury for major vascular nerves, little influence on donor area, being simple to operate, being better feelings of the finger pulp, ap- pearance, dorsal neurocutaneous vascular flap on repairing soft tissue defects of the thumb distal is an ideal choice.