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APPLICATION OF THE DORSOULNAR ARTERIAL RETROGRADE FLAP OF THE THUMB TO REPAIR OF SOFT TISSUE DEFECT AT THE DISTAL THUMB

Objective To introduce the surgical procedure and indication of the dorsoulnar arterial retrograde flap of the thumb in repair of soft tissue defect. Methods From March 2000 to March 2001, 12 cases of soft tissue defect with exposed bone at the distal thumb were involved. Ten flaps were pedicled distally at the proximal rotation point, 25 cm proximal to the cuticule. Two flaps were pedicled distally at the distal rotation point, 1.0 cm proximal to the cuticule. The flaps harvested in this study were 1.1 cm×1.3 cm to 1.8 cm×2.5 cm.Results All the flaps survived. After an follow-up of 2 to 14 months postoperatively, the appearance of the thumbs were satisfactory, except those of 2 thumbs repaired by the flaps transferred at the distal rotation point, which were bulkiness because of theuncovered pedicle. In 6 cases, the defect of finger pulp was repaired, and the 2point discrimination was measured 810 mm. The same range of motion of the thumb IP joint were observed in both sides in all cases.Conclusion The optimal indication of the procedure is soft tissue defect at the distal thumb.

耳廓修复与再造

Application of delayed skin-stretching device in treatment of skin and soft tissue defects

ObjectiveTo summarize the effectiveness of delayed skin-stretching device in treatment of skin and soft tissue defects.MethodsBetween December 2014 and December 2016, 10 cases of skin and soft tissue defects were treated with delayed skin-stretching device. There were 6 males and 4 females with an average age of 53 years (range, 42-64 years). The skin and soft tissue defects were caused by acute trauma in 6 cases. The incision could not be closed directly after making incisions because of osseous fascia syndrome in 3 cases. The skin soft tissue defect caused after huge carbuncle incision and drainage in 1 case. The defect located at thigh in 4 cases, lower leg in 3 cases, upper arm in 2 cases, back in 1 case. The defect area ranged from 10 cm×4 cm to 22 cm×12 cm. Pinch test was performed on the wound margin, which confirmed that the wound could not be closed directly.ResultsTension blisters were found in 3 cases during traction, and no complications such as impaired blood circulation or skin necrosis occurred in all cases. Skin defects closed directly after continuously stretching for 7-18 days. No skin graft or free flap repair was performed in all patients. The wound healed well after operation. All the 10 patients were followed up 5-8 months (mean, 6.5 months). There was no necrosis around the wound margin and the scar was linear. The sensation and function were not affected.ConclusionDelayed skin-stretching device is an effective method to treat skin and soft tissue defects, which has the advantages of simple operation, lower risk of operation, less complications, and reliable effectiveness.

动脉化静脉皮瓣修复手指软组织缺损

目的 探讨应用动脉化静脉皮瓣修复手指皮肤软组织缺损的方法及效果。方法 1999年10月～2006年8月,采用动脉化静脉皮瓣修复手指皮肤软组织缺损12例，男9例，女3例；年龄18～52岁。受伤原因：挤压伤8例，撕脱伤2例，锐器伤2例。均为手指软组织缺损，同时伴有骨、肌腱外露或合并血管断裂缺损，缺损范围为2.5 cm×1.0 cm～3.0 cm×2.5 cm。均采用同侧前臂、腕掌侧近端游离的动脉化静脉皮瓣修复。结果 术后2例远端1/4皮肤坏死，10例完全成活。患者全部获随访3～20个月，平均8个月。指肤色稍暗，皮肤质量接近正常，外观较丰满，感觉功能得到部分恢复。按中华医学会手功能评定标准评：优5指，良4指，中3指，差0指，优良率为75%。结论 应用动脉化静脉皮瓣是修复手指皮肤软组织缺损较好的一种方法。

指固有动脉背侧穿支螺旋桨皮瓣修复指端缺损

目的总结指固有动脉背侧穿支螺旋桨皮瓣修复指端缺损的方法和疗效。 方法2013年6月-2015年1月，应用指固有动脉背侧穿支螺旋桨皮瓣修复20例（20指）指端缺损。男15例，女5例；年龄20～47岁，平均32岁。致伤原因：挤压伤8例，切割伤12例。损伤指别：拇指3例，示指7例，中指9例，环指1例。创面范围1.5 cm×1.2 cm～1.8 cm×1.5 cm；均伴指骨外露。皮瓣切取范围为2.0 cm×1.5 cm～3.0 cm×1.8 cm。供区以皮瓣小桨及游离植皮修复。 结果术后4例皮瓣出现静脉危象，对症处理后逐渐好转；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区植皮均成活，切口Ⅰ期愈合。患者均获随访，随访时间6～9个月，平均7.4个月。皮瓣修复后指端外形良好，无指甲畸形，术后9个月皮瓣两点辨别觉达3.4～5.8 mm，平均3.9 mm。手功能按手指关节总活动度（TAM）法评定：获优15例，良3例，可2例，优良率90%。 结论应用指固有动脉背侧穿支螺旋桨皮瓣修复指端缺损，避免损伤主干血管，皮瓣修复患指后外观良好，不影响指间关节活动度，疗效满意。