Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap
Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap
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DOI：
10.1016/j.jhsa.2010.06.030
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发表时间：
2010-10-01
影响因子：
1.9
通讯作者：
Liu, Dequn
中科院分区：
文献类型：
--
作者：
Chen, Chao;Zhang, Xu;Liu, Dequn
目的应用改良第一掌背动脉（FDMA）皮瓣修复拇指末节脱套伤。方法2006年5月至2008年2月，应用改良的第一掌背动脉（FDMA）皮瓣修复拇指末节脱套伤11例。所有患者均发生拇指尖脱套伤，4例伴有长度为1 - 3 mm（平均2 mm）的骨丢失。软组织缺损长2.6 ~ 4.6cm（平均3.5cm），宽1.8 ~ 2.2cm（平均2.0cm）。皮瓣大小范围为2.7 x 2.2 cm至4.8 x 2.1 cm（平均3.6 x 2.1 cm）。平均椎弓根长度为7.2 cm（范围：6.8-7.5 cm）。所有病例均行双侧DBPDN与指固有神经之间的神经缝合术。患者随访时间为26至47个月（平均32个月）。用静态两点辨别觉评价再造拇指的感觉。测量供指的活动范围。结果皮瓣全部成活，皮瓣成活率为95.5%。最终随访时，皮瓣远端桡侧和尺侧的静态2点辨别力平均值分别为5 mm（范围，4-8 mm）和6 mm（范围，4-8 mm）。桡、尺侧远端皮瓣的平均值分别为对侧的75%和72%。供指的掌指关节、近端指间关节和远端指间关节的平均活动范围分别为73度、101度和70度。结论改良的FDMA皮瓣，包括两种DBPDN，可用于拇指指尖感觉的恢复和拇指足够长度的维持。（J Hand Surg 2010;35A：1663-1670.版权所有（C）2010美国手外科学会。版权所有© 2016
Purpose This study reports repair of a thumb tip degloving injury using the modified first dorsal metacarpal artery (FDMA) flap, including both dorsal branches of the proper digital nerve (DBPDNs).Methods From May 2006 to February 2008, the modified FDMA flap was used in 11 thumbs in 11 patients. All patients suffered a degloving injury to the thumb tip, and 4 had associated bone loss ranging from 1 to 3 mm (mean, 2 mm) in length. The size of the soft tissue defects was 2.6 to 4.6 cm (mean, 3.5 cm) in length and 1.8 to 2.2 cm (mean, 2.0 cm) in width. The flaps ranged in size from 2.7 x 2.2 cm to 4.8 x 2.1 cm (mean, 3.6 x 2.1 cm). The mean pedicle length was 7.2 cm (range, 6.8-7.5 cm). Neurorrhaphy between the DBPDN and the proper digital nerve was performed in both sides in all cases. Patient follow-ups ranged from 26 to 47 months (mean, 32 mo). Sensibility of the reconstructed thumb was evaluated by static 2-point discrimination. The range of motion of the donor fingers was measured. The data were compared to those of the opposite sides.Results All flaps survived completely. At the final follow-up, the mean values of static 2-point discrimination were 5 mm (range, 4-8 mm) and 6 mm (range, 4-8 mm) on the radial and ulnar sides of the distal portion of the flap, respectively. The mean values of the radial and ulnar distal portions of the flaps reached 75% and 72% of those of the opposite sides. The mean range of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the donor fingers were 73 degrees, 101 degrees, and 70 degrees, respectively.Conclusions The modified FDMA flap, including both DBPDNs, is useful for restoration of sensation on the thumb tip and maintenance of adequate length of the thumb. (J Hand Surg 2010;35A:1663-1670. Copyright (C) 2010 by the American Society for Surgery of the Hand. All rights reserved.)