应用不同种类皮瓣修复手指深度烧伤  

REPAIR OF FINGER DEEP BURN WITH DIFFERENT KINDS OF SKIN FLAPS

作　　者：阮建春 施耘[1] 刘群[1] 冯世海[1] 

机构地区：[1]天津第四医院烧伤整形科天津市烧伤研究所,天津300222

出　　处：《中国修复重建外科杂志》2007年第12期1277-1280,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用不同种类皮瓣修复手指深度烧伤的方法及效果。方法1997年1月～2006年12月,应用脐旁皮瓣、髂腹股沟皮瓣、指掌推进皮瓣、示指背岛状皮瓣、指侧方神经血管蒂岛状皮瓣和掌背皮神经营养血管蒂岛状皮瓣修复手指深度烧伤101例157指。男78例,女23例;年龄12～56岁,平均34.6岁。深度37例59指,度64例98指。创面缺损范围1.0cm×1.0cm～6.5cm×6.0cm。89例伤后4h～5d行皮瓣修复术,12例感染创面于伤后18～27d行皮瓣修复术。术中皮瓣切取范围1.2cm×1.2cm～7.8cm×6.5cm,供区直接缝合84例,游离植皮17例。结果术后98例皮瓣成活良好,切口期愈合;3例皮瓣边缘淤血坏死,经换药后期愈合。供区均期愈合。101例患者均获随访2～24个月,平均6.5个月。9例脐旁皮瓣和14例腹股沟皮瓣修复手指臃肿,余外形满意。患指两点辨别觉为5～10mm,皮瓣耐磨,有弹性,手指屈曲、伸展功能恢复满意。结论指掌推进皮瓣、示指背岛状皮瓣、指侧方神经血管蒂岛状皮瓣、掌背皮神经营养血管蒂岛状皮瓣修复手指深度烧伤临床效果良好,脐旁皮瓣、髂腹股沟皮瓣对多指深度烧伤修复效果好,但术后手指略显臃肿。Objective To investigate an effective method in clinical application of using different kinds of skin flaps for repair of the finger deep burns. Methods The groin skin flap, the paraumbilical skin flap, the volar digital advancement flap, the island flap from the dorsum of the index finger, the lateral digital neurovascular island flap, and the island skin flap nourished by the cutaneous nerve nutrient vessel of the dorsum were employed to repair 157 fingers in 101 patients （78 males, 23 females, aged 12-56 years, averaged 34.6 years） from January 1997 to December 2006. Of the 101 patients, 37 had a deep partial thickness burn involving 59 fingers, and 64 had a full thickness burn involving 98 fingers. The soft tissue defects ranged in area from 1.0 cm× 1.0 cm to 6.5 cm × 6.0 cm. The interval between the injury and the operation was 4 hours to 5 days in 89 patients, and 18 to 27 days in the other 12 patients who also had infected wounds. The flaps ranged in size from 1.2 cm × 1.2 cm to 7.8 cm× 6.5 cm. The donor site was directly sutured in 84 patients, and the donor site was covered by a full thickness skin graft in the other 17 patients. Results After operation, 98 patients had an incision healing by first intention and the flaps survived well;the other 3 patients had congestion and necrosis in the flap edges, and had a delayed healing after the dressing changes. All the donor sites had a healing by first intention. The follow-up of all the patients for 2-24 months averaged 6. 5 months revealed that 9 patients, who had been given the paraumbilical skin flap, had a fat and clumsy finger; 14 patients, who had been given the groin skin flap, also had a fat and clumsy fingers 3 patients developed congestion and necrosis at their edges. The remaining patients had a satisfactory survival of the skin flaps and a normally-shaped finger. The flaps had a good appearance, with the two-point discrimination of 5-10 mm, the good finger motion ability, and the satisfactory finger appearance. Conclusion The volar digita

关 键 词：手指 烧伤 皮瓣 修复 

分 类 号：R658[医药卫生—外科学] R644[医药卫生—临床医学]