目的:探讨指动脉背侧支带蒂皮瓣与V-Y推进皮瓣瓦合修复手指指端脱套伤及掌背动脉返支逆行带蒂岛状皮瓣接力修复近节背侧供区软组织缺损的效果。方法:2016年6月—2019年1月，唐山市第二医院手外科收治21例第2 ~ 5指指端脱套伤患者，其中男14例、女7例，年龄24 ~ 60岁，进行回顾性临床随访研究。采用近位带蒂指动脉背侧支皮瓣与V-Y推进皮瓣瓦合修复指端创面，清创后创面面积为2.0 cm×1.5 cm~3.5 cm×2.2 cm。于患指近节背侧设计带指固有神经背侧支和指背神经的指动脉背侧支带蒂皮瓣末节背侧创面，皮瓣面积为1.6 cm×1.5 cm~2.6 cm×2.4 cm；于患指掌侧V-Y推进皮瓣修复末节掌侧创面，皮瓣面积为0.8 cm×0.6 cm~2.0 cm×1.5 cm；采用掌背动脉返支逆行带蒂岛状皮瓣修复近节背侧供区软组织缺损，皮瓣面积为1.8 cm×1.7 cm~2.8 cm×2.6 cm，手背部皮瓣供区直接分层缝合。观察术后3种皮瓣成活情况及随访时皮瓣的血运、外观、静态两点辨别觉距离。末次随访，采用Michigan手部功能问卷评定标准n [评估患者对手部外观的满意度；参照中华医学会手外科学会上肢部分功能评定试用标准评估患指关节总活动度（TAM）。n 结果:术后63个皮瓣完全成活，其中1个指动脉背侧支带蒂皮瓣表面出现张力性水疱，经拆除蒂部缝线、换药处理后创面愈合。随访6 ~ 20个月，平均12个月，3种皮瓣外形美观、质地柔软、色泽与周围组织相近，手背供区仅残留线性瘢痕。末次随访时，掌侧V-Y推进皮瓣静态两点辨别觉距离为4 ~ 7 mm，背侧指动脉背侧支带蒂皮瓣为5 ~ 10 mm，掌背动脉返支逆行带蒂岛状皮瓣为8 ~ 15 mm。16例患者对手部外观非常满意，5例患者表示满意；患指TAM评定为优17例、良4例。结论:指动脉背侧支带蒂皮瓣与V-Y推进皮瓣瓦合修复手指指端脱套伤及掌背动脉返支逆行带蒂岛状皮瓣接力修复近节背侧供区软组织缺损，手术方式简单可靠，患指外观、功能恢复良好，供区副损伤小，是修复指端脱套伤一种较好的方法。“,”Objective:To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum.Methods:A total of 21 patients with degloving injury of fingertip at the 2nd to 5th finger were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females with ages ranging from 24 to 60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured fingers joint was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association.Results:All flaps survived after operation. Tension blisters appeared on surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and there was only linear scars in donor site of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured fingers joint was evaluated as excellent in 17 cases, good in 4 cases.Conclusions:The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal subsidiary-injury.