仅吻合动脉的腕横纹皮瓣与两种传统皮瓣修复指端缺损的对比研究OA

Objective To systematically evaluate the clinical outcomes of the artery-only anastomosed wrist crease flap(A-WCF),the conventional arteriovenous anastomosed wrist crease flap(V-WCF),and the reverse digital artery island flap(RDF)in repairing small to medium-sized fingertip defects.Methods A retrospective analysis was conducted on 65 patients with 67 fingertip defects admitted to the Burn,Plastic,and Hand Surgery Department of the 971st Navy Hospital between June 2018 and November 2024.According to the different repair methods,the injured fingers were divided into three groups:A-WCF group(n=21),V-WCF group(n=23),and RDF group(n=23).Operative time,perioperative incidence of circulatory disturbances(ecchymosis,tension blisters),complete flap survival rate,and long-term aesthetic outcomes(scarring at donor and recipient sites,joint function)were compared and analyzed among the three groups.Results The final survival rate of flaps was 100% in all three groups.There was a difference in operative time:shortest in the RDF group(1.10±0.17)h,followed by the A-WCF group(2.43±0.15)h,and longest in the V-WCF group(3.32±0.18)h(P＜0.05).The perioperative incidence of circulatory disturbances was higher in the RDF group(30.43%)compared to the A-WCF group(4.76%)and the V-WCF group(4.34%)(P＜0.05).Long-term follow-up showed that 6 cases(26.09%)in the RDF group developed scar contracture in the injured finger,with 3 of these requiring secondary surgical release,while this complication did not occur in either wrist crease flap group(P＜0.05).The scar at the wrist donor site was more concealed in the A-WCF group.Conclusion For fingertip defects with an area ranging from 1.0 cm² to 2.5 cm²,both types of wrist crease flaps are superior to the reverse digital artery island flap in terms of vascular reliability and long-term aesthetic outcomes.Among them,the artery-only anastomosed wrist crease flap(A-WCF),while ensuring equivalent repair effcacy,reduces operative time and simplifies the procedure compared to the conventional arteriovenous anastomosis technique.It is particularly suitable for cases with poor recipient vein conditions,representing an optimal surgical option that combines effciency and effectiveness.