双足带有同蒂多叶皮瓣的趾甲皮瓣移植治疗全手皮肤套脱伤  

Repair of degloving injury of the entire hand by bilateral combined transfer of wrap-around flap and mulll-petal pedal flaps based on a single pedicle

作　　者：侯瑞兴[1] 王海文 巨积辉[1] 郭大强 陈宏彬 江新民 盛进 

机构地区：[1]苏州瑞兴医院,江苏215128 [2]广州新江南手外科医院

出　　处：《中华手外科杂志》2009年第1期32-34,共3页Chinese Journal of Hand Surgery

基　　金：江苏省自然科学基金资助项目（BK2008178）

摘　　要：目的探讨应用组合组织移植修复全手皮肤套脱伤的方法。方法对3例全手皮肤套脱伤患者，分别采用一侧足部以胫前动脉为蒂的带踝前皮瓣、足背皮瓣、足内侧皮瓣和足外侧皮瓣的躅甲皮瓣再造拇指，修复桡侧手掌手背及虎口区皮肤缺损；另一侧足部带以上相同皮瓣的第二趾甲皮瓣再造示指（或中指），修复尺侧手掌及手背皮肤缺损。结果术后3例，除一再造示指坏死外，其余组织瓣全部存活。术后随访3～12个月，修复后手部外形和捏、握、抓等功能基本恢复。皮瓣及再造拇、示指（或中指）感觉恢复至S2～S4。结论双足带有同蒂多叶皮瓣的趾甲皮瓣移植治疗全手皮肤套脱伤是一种有效的治疗方法。Objective To explore a new operative method of repairing degloving injury of the entire hand by composite transfer. Methods A total of 3 cases of hand degloving injuries were treated with flap transfers from both feet. Wrap-around flap from one foot combined with anterior ankle flap, dorsal pedal, medial pedal and lateral pedal flaps all based on the anterior fibial artery were transferred to reconstruct the thumb and cover skin defects of the web space and the thumb and radial side of the hand. The second toe combined with abovementioned pedal flaps were harvested from the other foot and transferred to reconstruct the index or middle finger and cover skin defects on the ulnar side of the hand. Results All the skin flaps survived postoperatively, except necrosis of a reconstructed index finger. Follow up ranged from 3 to 12 months. The appearance of the hand and functions such as pinch, grasp and grip recovered essentially. The sensation of the flaps and reconstructed digits returned to S2 to S4. Conclusion Combined transfer of wrap-around flap and multi-petal flaps based on one pedicle from both feet is an effective way to repair degloving injury of the entire hand.

关 键 词：手损伤 组织移植 显微外科手术 套脱伤 

分 类 号：R686[医药卫生—骨科学]