PDF(Pubmed)
Abstract：
BACKGROUND: Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss.
METHODS: Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively.
RESULTS: Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5.
CONCLUSIONS: The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.
METHODS: Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively.
RESULTS: Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5.
CONCLUSIONS: The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.
摘要：
背景：对于远端手指和牙髓缺损，存在各种重建选择，包括移植和局部或远处的皮瓣。除了重建正常的解剖结构,保持手指的感觉功能至关重要。这项研究介绍了使用植骨结合螺旋皮瓣（BGcSF）技术重建伴有骨质流失的牙髓缺损的结果。
方法：采用BGcSF技术治疗23例指尖缺损患者。术后六个月，通过Semmes-Weinstein单丝（SWM）和静态两点辨别（2PD）测试评估皮瓣敏感性。在测试后一年，使用耐冷性严重程度评分（CISS）问卷评估受影响手指的耐冷性。使用密歇根手部结果问卷（MHQ）评估患者满意度。术后一年用测角仪测量近端和远端指间关节的运动范围（ROM）。
结果：远端皮瓣坏死，影响10-15%的皮瓣区域,在一名患者中观察到。未发现其他并发症。术后6个月的平均静态两点判别值为5.6mm,平均SWM评分为3.56。术后1年的平均CISS评分为18.8分。近端指间关节的平均活动ROM角为106.7度，对于远端指间关节，是65.4度。术后1年平均MHQ评分为18.5。
结论：BGcSF技术为软组织提供了与指尖相似的质地，并支持有效的感觉修复。在无法再植的情况下，可以将其视为指尖重建的可行选择。
方法：采用BGcSF技术治疗23例指尖缺损患者。术后六个月，通过Semmes-Weinstein单丝（SWM）和静态两点辨别（2PD）测试评估皮瓣敏感性。在测试后一年，使用耐冷性严重程度评分（CISS）问卷评估受影响手指的耐冷性。使用密歇根手部结果问卷（MHQ）评估患者满意度。术后一年用测角仪测量近端和远端指间关节的运动范围（ROM）。
结果：远端皮瓣坏死，影响10-15%的皮瓣区域,在一名患者中观察到。未发现其他并发症。术后6个月的平均静态两点判别值为5.6mm,平均SWM评分为3.56。术后1年的平均CISS评分为18.8分。近端指间关节的平均活动ROM角为106.7度，对于远端指间关节，是65.4度。术后1年平均MHQ评分为18.5。
结论：BGcSF技术为软组织提供了与指尖相似的质地，并支持有效的感觉修复。在无法再植的情况下，可以将其视为指尖重建的可行选择。
