Chinese Journal of Reparative and Reconstructive Surgery, June 2009, V ol. 23, No.6·660·改良逆行指背筋膜蒂皮瓣修复手指软组织缺损李志安1 李振武1 张桂萍2【摘 要】 目的探讨采用改良指背筋膜蒂皮瓣逆行移位修复手指软组织缺损的手术方法，以及预防降低静脉危象发生的临床疗效。
方法2005年2月－2007年3月，收治手指软组织缺损19例22指。
男14例17指，女5例5指。
年龄2～62岁，中位年龄26岁。
切割伤8例，挤压伤6例，撕脱伤4例，热压伤1例。
其中拇指3指，示指7指，中指6指，环指4指，小指2指。
软组织缺损范围为1.5 cm × 0.8 cm～5.5 cm × 1.5 cm。
受伤至手术时间为2～11 h，平均7 h。
术中采用以各指优势动脉侧指横纹末端连线为轴线，皮瓣偏向指背侧，呈“b、d”样，切取大小为1.8 cm × 1.0 cm～6.0 cm ×2.0 cm逆行指背筋膜蒂皮瓣修复缺损。
供区植皮打包固定。
结果术后皮瓣全部成活，无静脉危象及明显肿胀发生，切口均Ⅰ期愈合。
供区植皮全部成活。
患者术后均获随访，随访时间6～18个月，平均11个月。
术后皮瓣色泽、质地与伤指皮肤相近，指腹饱满。
两点辨别觉为8～11 mm。
患指指间关节活动正常。
结论经逆行指背筋膜蒂皮瓣设计及切取方法的改良修复手指软组织缺损，可有效减少术后静脉危象的发生，是一种简便有效的治疗方法。
【关键词】 手指 软组织缺损逆行指背筋膜蒂皮瓣修复中图分类号： R658.2 R622.1 文献标志码：AREPAIR OF SOFT TISSUE DEFECT IN FINGER WITH MODIFIED REVERSE DORSAL DIGITAL FASCIA FLAP/LI Zhian1, LI Zhenwu1, ZHANG Guiping2. 1Department of Osteoarticular Hand Surgery, Center Hospital of Nanyang, Nanyang Henan, 473009, P.R.China; 2the First People’s Hospital of Nanyang. Corresponding author: LI Zhian, E-mail: lizhian1@ 【Abstract】 Objective To investigate the operative method of repairing soft tissue defect of finger with modified reverse dorsal digital fascia flap and its clinical effect of preventing and treating venous crisis.Methods From February2005 to March2007,19cases(22fingers)with soft tissue defect of finger were treated,including14males(17fingers)and5females (5fingers)aged2-62years old(median26years old).There were8cases of cutting injury,6cases of crush injury,4cases of avulsion injury,and1case of hot crush injury,involving3thumbs,7index fingers,6middle fingers,4ring fingers and2little fingers.The size of soft tissue defect was1.5cm×0.8cm-5.5cm×1.5cm,and the time from injury to operation was2-11hours (average7hours).The axis of flaps was the line of transverse striation of fingers via dominant artery.The flaps were deflected dorsally,as“b”or“d”,to cover the wounds.Reverse dorsal digital fascia flaps1.8cm×1.0cm-6.0cm×2.0cm in size were adopted to repair the defects.The donor site underwent skin grafting fixation.Results All flaps survived,without venous crisis and obvious swollen.The grafted skin in the donor site all survived.All patients were followed for6-18months(average11 months).Postoperatively,color and texture of the grafted flaps were similar to that of normal skin,and the pulp of the fingers was normal.The two-point discrimination was8-11mm,and the activities of interphalangeal joint of all injured fingers were normal.Conclusion The modified reverse dorsal digital fascia flap is ideal for repairing soft tissues defects of the fingers, and can decrease the occurrence of venous crisis.【key words】Finger Soft tissue defect Reverse dorsal digital fascia flap Repair手指软组织缺损后的修复方法很多[1-5]。
