张栋 杨波 夏冬雪 常兴华

【摘要】 目的：探讨改良Moberg推进皮瓣修复指端指腹皮肤缺损。方法：采用改良Moberg岛状推进皮瓣治疗指端掌侧缺损16例，平均随访8个月。对Moberg皮瓣的改良包括在皮瓣近端采用双边“Z”成形，远端克氏针牵引。游离皮瓣仅保留神经血管蒂，内含双侧指固有神经和一侧指固有血管，保留指背神经的连续性。结果：皮瓣全部成活，在外观、感觉以及运动功能等方面疗效满意，术后3月手指活动TAM优良率为83.3%（15/18），指端两点辨别觉达到5 mm以内。结论： 改良Moberg岛状推进皮瓣进一步增加了推进距离，术后功能恢复良好，并发症少。

【关键词】 组织缺损； 指腹； Moberg皮瓣

Repair of Soft Tissue Defect of Finger Pulp with Modified Moberg Flap/ZHANG Dong，YANG Bo，XIA Dong—xue，et al.//Medical Innovation of China，2012，9（29）：113—114

【Abstract】 Objective：To report the result of modified Moberg flap for repair the defects of finger pulp.Method：From March 2005 to May 2007，16 cases（18 defective finger pulps） were cured with modified Moberg flap.Except one side of digital artery，the neurovascular bundles were reserved in the flap and turned into the pedicles with the dorsal digital nerves intact.Z epicanthoplasty was adopted at the proximal side of the flap，furthermore，the terminal side of the flap was tract by a Kirschner wire at the top of the finger tip.Result：The mean following—up was 8 months.All the flaps survived.The clinical results were satisfactory，including sensibility and joint activity.The excellent and good rate of TAM fingers activities was 15/18（83.3%），two—points discrimination were less than 5 mm within 3 months after operation.Conclusion：Repair of soft tissue defect of finger pulp with this kind of modified Moberg flap resulted in reliable curative effect，not only advancing more distance，but also keeping complications down.

【Key words】 Defect of soft tissue； Finger pulp； Moberg flap

Frist—authors address： Jinzhou District Peoples Hospital of Dalian， Dalian 116100，China

doi：10.3969/j.issn.1674—4985.2012.29.076

目前Moberg推进皮瓣在修复指腹软组织创伤性缺损的临床实践中不断被改进，其修复效果有了极大的提高[1]，指端和指背侧皮肤坏死等并发症发生率不断减低。但该皮瓣术中推进距离有限和术后患指普遍存在指背感觉减退亟待有效方法解决[2]。2005年3月—2007年5月笔者进一步改进Moberg皮瓣，在增加推进幅度和保留指背感觉方面效果理想，报道如下。

1 资料与方法

1.1 一般资料 手指指腹组织缺损急诊手术16例18指，其中男12例14指，女4例4指。年龄17～45岁，平均（29±8）岁，右手13指，左手5指。6拇指，6中指，4食指，2环指。机器轧伤9例，刀具切割伤7例，所有病例指骨完整，甲床缺失不超1/4，指腹缺损近缘不超过远指间关节，缺损纵向长度<3.0 cm。指骨骨外露8指，均在伤后3 h内手术，于指根神经阻滞麻醉下行改良Moberg岛状推进皮瓣修复术。

1.2 手术方法 麻醉满意后，上臂气囊止血带止血，锐性伤口开始于手指侧方正中切开全层皮肤及皮下，皮瓣设计不需超过指蹼的掌屈纹水平。……