目的 探讨递进式皮下蒂双V-Y皮瓣联合甲床扩大术修复部分甲床缺损的指端缺损的临床效果。 方法 自2015年6月至2019年6月对17例19指指端横断缺损伴甲床缺损的患者采用同指递进式皮下蒂双V-Y推进皮瓣联合甲床扩大术治疗。患指创面面积为1.0 cm × 0.8 cm ~ 1.6 cm × 1.5 cm。随访观察术后伤指功能、外观，以及钩甲畸形发生率。 结果 术后随访8 ~ 24月，平均13个月。19指皮瓣全部成活，皮瓣感觉恢复达S4级。重建后指端呈弧形，手指外观满意，关节活动正常。指甲外观、质地良好；甲床长度平均增加3.3 mm（2 ~ 4 mm）；均未出现钩甲畸形，指甲再生优良率为94%。 结论 递进式双V-Y皮瓣联合甲床扩大术修复伴甲床缺损的指端横断缺损，在重建指端及指甲外形的同时，减少了钩甲畸形的发生率，使伤指最大限度地恢复外形与功能，是一种疗效确切、便于操作的手术方法。
关键词：
指损伤； ; ; 外科皮瓣； ; ; 缺损； ; ; 甲畸形
Objective To investigate the clinical effect of progressive subcutaneous pedicle double V-Y flap combined with nail bed augmentation in the repair the transverse defect of fingertip and partial nail bed defect. Methods From June 2015 to June 2019, 17 patients with transverse defect of fingertip and nail bed defect were treated with progressive subcutaneous pedicle double V-Y flap combined with nail bed augmentation. The area of the affected finger wound was 1.0 cm× 0.8 cm ~ 1.6 cm× 1.5 cm. The fingers were followed-up in function, appearance and incidence of hook nail deformity. Results The postoperative follow-up period was 8 to 24 months, 13 months on average. All the 19 flaps survived well. The sensory recovery of 19 flaps reached S4 grade. The reconstructive fingers formed arc-shaped fingertips with nails of good appearance and texture. The appearance of the fingers was satisfactory and the joint movement was normal. The length of the nail bed increased by 2~4 mm, 3.3 mm on average. There was no hook nail deformity in each finger. The excellent rate of nail regeneration was 94%. Conclusions Progressive subcutaneous pedicle double V-Y flap combined with nail bed augmentation can repair the transverse defect of fingertip and nail bed defect, and reduce the incidence of hook nail deformity while reconstructing the shape of fingertip and nail. It is an effective and simple surgical method for injured finger to reconstruct the shape and function to the maximum extent.
[1] Panattoni JB, De Ona IR, Ahmed MM. Reconstruction of fingertip injuries: surgical tips and avoiding complications[J]. J Hand Surg Am, 2015, 40(5): 1016-1024. DOI: 10.1016/j.jhsa.2015.02.010.
[2] Sindhu K, DeFroda SF, Harris AP, et al. Management of partial fingertip amputation in adults: operative and non operative treatment[J].Injury, 2017, 48(12): 2643-2649. DOI: 10.1016/j.injury. 2017. 10.042.
[3] 侯春林, 顾玉东. 皮瓣外科学[M]. 上海: 上海科学技术出版社, 2006: 515-516, 534.
[4] 林涧, 余云兰, 王正理, 等. 甲床延长术的临床应用研究[J]. 实用骨科杂志, 2008, 14(1): 43-44. DOI: 10.3969/j.issn.1008-5572.2008.01.018.
[5] 王瑞, 苗平, 葛华平, 等. 断层甲床移植在修复手指甲床部分缺损中的疗效[J]. 实用手外科杂志, 2016, 30(2): 169-170, 200. DOI: 10.3969/j.issn.1671-2722.2016.02.015.
[6] 王利, 杨涛, 李文庆, 等. 指甲扩大术的解剖学基础[J]. 中国临床解剖学杂志, 2003, 21(3): 245-246. DOI: 10.3969/j.issn.1001-165X.2003. 03.019.
[7] 张涛, 张勇. 自体指(趾)甲甲模在炎症性拔甲术后的应用[J]. 中华整形外科杂志, 2004, 20(3): 183. DOI: 10.3760/j.issn:1009-4598.2004. 03.026.
[8] 潘生德, 顾玉东, 侍德. 中华医学会手外科学会上肢部分功能评定试用标准[J]. 中华手外科杂志, 2000, 16(3): 130. DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003.
[9] 李宝山, 章雪松, 杨飞, 等. 矩形推进皮瓣及甲床扩大成形术治疗合并指甲部分缺失的指远端损伤[J]. 中华手外科杂志, 2002, 18(3): 151-152. DOI: 10.3760/cma.j.issn.1005-054X.2002.03.010.
[10]Miller AJ, Rivlin M, Kirkpatrick W, et al. Fingertip amputation treatment: a survey study[J]. Am J Orthop(Belle Mead NJ), 2015, 44(9): E331-E339.
[11] 李海, 魏在荣, 孙广峰, 等. 带感觉指固有动脉穿支V-Y推进皮瓣修复手指软组织缺损的临床应用[J]. 中华手外科杂志, 2018, 34(6): 401-403. DOI: 10.3760/cma.j.issn.1005-054X.2018.06.001.
[12]Sungur N, Kankaya Y, Yildiz K, et al. Bilateral V-Y rotation advancement flap for fingertip amputations[J]. Hand, 2012, 7(1): 79-85. DOI: 10.1007/s11552-011-9389-6.
[13] Regmi S, Gu J, Zhang N, et al. A systematic review of outcomes and complications of primary fingertip reconstruction using reverse-flow homodigital island flaps[J]. Aesthetic Plast Surg, 2016, 40(2): 277-283. DOI: 10.1007/s00266-016-0624-y.
[14] Zhu L, Xu QJ, Kou W, et a1. Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects[J]. Indian J Orthop, 2014, 48(6): 594-598. DOI: 10.4103/0019-5413.144228.
京ICP备08002354号-3
