关键词: 手指末节皮肤缺损, 皮瓣修复术, 临床效果

Abstract: Objective To observe the results of two surgical procedures,retrograde island fascia-tipped flap graft repair on the dorsum of the finger and retrograde island flap graft repair with the perforating branch of the finger web artery as the tip,in repairing skin defects at the end of the finger.Method From January 2020 to January 2023,100 patients with skin defects at the distal phalanges of the fingers were admitted.According to the survival status of the flaps,91 patients with surviving flaps were included and divided into two groups based on different repair methods,including 33 cases in the dorsal phalanx group and 58 cases in the webbed phalanges group.Compare the survival rate of flaps and the surgical outcomes of patients with surviving flaps in the two groups.Results The flap survival rate in the dorsal phalanx group (82.50%,33/40) was lower than that in the webbed phalanges group (96.67%,58/60),and the incidence of postoperative complications (27.27%) was higher than that in the webbed phalanges group (8.61%).There was a statistically significant difference between the two groups (P<0.05).The flap length and operation time [(6.02±1.20) cm,(61.27±7.15) min] in the dorsal finger group were shorter than those in the webbed finger group [(8.60±1.82) cm,(100.25±15.20) min],the wound healing time and hospital stay in the dorsal finger group were (18.02±3.50) days and (16.20±1.50) days respectively,which were longer than those in the webbed finger group [(13.50±2.77) days and (12.50±1.80) days],there was a statistically significant difference between the two groups (P< 0.05).The capillary filling times of the dorsal finger group at 7 days after the operation and on the day of discharge were (1.57±0.14) s and (1.12±0.08) s,respectively,which were longer than those of the webbed finger group [(1.13±0.10) s and (0.95±0.06) s],the sensory function scores were (2.51±0.34) points and (3.77± 0.38) points,respectively,which were lower than those of the webbing group [(3.34± 0.40) points,(4.12±0.21) points],and the difference between the two groups was statistically significant (P<0.05).The levels of IL-6 and TNF-α at 7 days after operation [(29.95±4.80) ng/L,(197.25±13.50) ng/L] were higher than those in the fingerweb group [(27.02±4.15) ng/L,(185.62±12.27) ng/L],the differences were statistically significant (P<0.05).The follow-up results showed that compared with the finger dorsal group,the hand function score of the finger web group was higher,the hand function recovery rate was higher（93.10% vs 81.82%）,and the two-point discrimination was shorter (P<0.05).Conclusion Different retrograde island flap repair methods can effectively repair the skin defect of the finger end and promote wound healing,among which the retrograde island flap repair with pedicled perforator of the finger web artery has the advantages of higher survival rate of the flap,more obvious improvement of hand function,and less postoperative inflammation,the retrograde island fascial flap transplantation repair of the dorsal finger is relatively short.

Key words: skin defects of the terminal phalanges of the fingers, flap repair, clinical results