联合岛状皮瓣修复合并指骨骨折的拇指套状撕脱

Restoration of thumb with degloving injury and phalangeal fracture using combined island flaps

  • 摘要: 目的:发掘修复拇指的简易方法。方法:据对手部皮肤血管解剖所见,形成拇指桡侧指背动脉掌背逆行岛状皮瓣、指固有动脉全指背岛状皮瓣以及虎口岛状皮瓣。结果:解剖发现拇指桡侧指背动脉与指固有动脉之间,有纤细交通支绕行于第一掌骨背侧及大鱼际肌表面;指固有动脉在行程中发出的指背支斜向远侧行走至指背与对侧分支吻合;拇主要动脉及食指桡侧指固有动脉均可见纤细分支至虎口区皮肤。临床应用上述皮瓣修复拇指14例,全部成功,其感觉、外形及功能恢复满意。结论:对于不要求指甲重建的拇指损毁或脱套伤,采用本法再造或修复是可行的。

     

    Abstract: Objective:To exploit simple operating methods of thumb reconstruction.Methods:We have carried out anatomical observation of cutaneous vessels of the hand. Based upon it, three island flaps were created, including: (1)dorsalmetacarpal island flap supplied by the reverse radial dorsal pollical artery; (2)total dorsal digital island flap supplied by the proper digital artery; (3)island flap of the first web space. Results:The anatomical observation leading to the discoveries as follows: (1)thin communicating branches between dorsal and palmar pollical artery revolve at dorsal side of the first metacarpal bone and surface of the major thenar muscles: (2)proper digital rtery gives off joint branches and dorsal digital branches in the course of advane, the latter obliquely pass to the dorsal digital side and anastomoses with the opponent ones; (3)both principal pollical artery and radial proper index artery give off visible thin branches to skin of the first web space. The flaps designed have been used to restore the thumb in 14 patients. All flaps survived well with satisfactory sensation, appearance and function of restored thumbs.Conclusion:Unless immediate nail restoration is in special request by the patient, thumb restoration using the aforementioned single or combined island flaps of the hand will be available.

     

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