关键词: 远节手指, 皮肤缺损, 岛状皮瓣修复术, 指侧支动脉, 指背侧支动脉

Abstract: Objective  Comparison of therapeutic effects between retrograde island flap of the intrinsic artery and dorsal perforator island flap for repairing skin defects at the distal phalanx of the finger.Methods  A total of 128 patients with skin defects at the distal phalanx of the finger were enrolled from August 2020 to September 2022 at Huai’an Second People’s Hospital.These patients had 128 affected fingers.Using a random number table,they were divided into two groups:collateral group (64 case) and dorsal branch group (64 case).The collateral group underwent retrograde island flap surgery using the intrinsic artery,while the dorsal branch group underwent repair surgery using the dorsal perforator island flap of the intrinsic artery.Surgical time and intraoperative blood loss were recorded.Follow-up was conducted for 12 months postoperatively,evaluating graft survival rate,finger joint function,sensory function of the transplanted flap at the distal phalanx,degree of wound scar,and postoperative complications.Results The surgical time for the collateral branch group and the dorsalis branch group was (50.03±12.41) minutes and (54.78±15.65) minutes,respectively.The intraoperative blood loss was (22.65±10.03) ml in the collateral branch group and (26.52±12.61) ml in the dorsalis branch group.There was no statistically significant difference in surgical time or intraoperative blood loss between the two groups (P＞0.05).At the 12month follow-up,all patients in both groups had normal healing of the distal defect,and the success rate of flap transplantation was 100.00% in both groups.There was no statistically significant difference between the groups in terms of flap transplantation success rate (P＞0.05).At the 12month postoperative period,the Vancouver Scar Scale (VSS) score was (3.15±0.69) in the collateral branch group and (3.17±0.62) in the dorsalis branch group,with no statistically significant difference between the two groups (P＞0.05).The Tangibility,Appearance,and Mobility (TAM) score was (9.71±0.65) in the collateral branch group and (10.93±0.71) in the dorsalis branch group.The TAM score was significantly lower in the collateral branch group compared to the dorsalis branch group (P<0.05).The two-point discrimination of the flaps was (8.93±2.05) mm in the collateral branch group and (7.51±1.64) mm in the dorsalis branch group.The two-point discrimination was significantly higher in the collateral branch group compared to the dorsalis branch group (P<0.05).There were 2 cases of venous reflux disorder and 1 case of cold intolerance in the collateral branch group,while no complications occurred in the dorsalis branch group.There was no statistically significant difference in complications between the two groups (P＞0.05).Conclusion  Compared to the reverse island flap repair using the intrinsic arterial system,the dorsal island flap repair using the intrinsic arterial system for treating distal skin defects of the finger provides better postoperative functional recovery of the finger and relatively lower risk of venous congestion.

Key words: distal finger, distal phalanx, skin defect, island flap repair surgery, collateral artery of the finger, dorsal branch artery of the finger