游离膝上外皮瓣移植覆盖甲皮瓣切除后的创面  

Resurfacing of donor site defect after extended wrap-around flap transfer with a free superolateral genual flap

作　　者：潘勇卫[1] 栗鹏程[1] 李玉成[1] 易传军[1] 田光磊[1] 

机构地区：[1]北京大学第四临床医学院北京积水潭医院手外科,100035

出　　处：《中华手外科杂志》2007年第2期89-92,共4页Chinese Journal of Hand Surgery

基　　金：北京市优秀人才专项基金(20042d0300207)

摘　　要：目的探讨甲皮瓣带足背皮瓣切取后,供区创面应用游离膝上外皮瓣移植覆盖的手术效果。方法2003年4月—2005年12月,我院对8例拇指大面积套状撕脱伤的患者,在进行游离甲皮瓣带足背皮瓣移植再造拇指的同时,再应用游离膝上外皮瓣移植覆盖足背供区的创面。结果术后再造拇指全部存活,覆盖足部供区的皮瓣全部存活。术后随访时间为6～18个月,再造拇指外形和功能良好,指腹两点分辨觉为6～8mm。供区趾保留全部长度,并有跖屈和背伸功能,但皮瓣较臃肿,其中4例行皮瓣修整术。供足及膝部行走、跑步均无疼痛。6例足功能分析显示,动态、静态足底应力分布与对侧十分接近,步态正常。结论利用游离膝上外皮瓣移植覆盖足背供区创面,能够很好地保留供足的功能。该方法尤其适用于拇指皮肤缺损较多,采用甲皮瓣移植再造时需扩大切取足背皮瓣供区创面的患者。Objective To evaluate the results of immediate resurfacing of the donor site defect of the big doe during wrap-around flap transfer procedures with a free superolateral genual flap. Methods From April 2003 to December 2005, 8 eases of degloving injury of the thumb combined with soft tissue Ices of the radial-dorsal hand were treated in our department. An extended wrap-around flap was harvested from the big toe along with a dorsalis pedis flap to reconstruct the thumb and cover the skin defect of the hand. Resurfacing of the donor site defect was done at the same time with a free superolateral genual flap. Results All transplants, including the ones at the recipient site and the ones at the donor site, survived. There was not a single flap loss. Follow-up time ranged from 6 months to 1.5 years postoperatively. The results for the reconstructed thumbs were good, both functionally and aesthetically. 2-PD at thumb pulp was 6-8 mm. The total length of the donor toes and a normal range of flexion and extension was preserved. The patients could walk and run normally, without pain or short- or long-term postoperative skin erosions or ulcerations. Static footprint analysis and dynamic mechanical analyses showed consistent results with those of the opposite side. Gait analysis was normal. Defatfing procedures were required in 4 cases. Conclusion Using free superolateral genual flap to cover defect of the big toe and foot during extended wrap-around flap transfer could achieve maximum preservation of the function and appearance of donor big toe. This procedure is especially indicated for closure of larger skin defects during extended wraparound flap transfer along with a dorsalis pedis flap.

关 键 词：外科皮瓣 组织移植 拇趾 拇指 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]