双髂腹股沟及腹部联合皮瓣修复前臂与手大面积皮肤缺损  

REPAIR OF LARGE SKIN DEFECT OF FOREARM AND HAND USING BILATERAL GROIN FLAPS AND ABDOMINAL FLAPS

作　　者：龚志鑫[1] 田德虎[1] 张经岐[1] 张桂生[1] 张冰[1] 王世辉[1] 刘建敏[1] 

机构地区：[1]河北医科大学第三医院手外科,石家庄050051

出　　处：《中国修复重建外科杂志》2009年第8期930-932,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的介绍一种修复前臂与手大面积皮肤缺损的手术方法。方法2003年7月-2008年9月,应用双髂腹股沟及腹部联合皮瓣修复前臂合并手部大面积皮肤缺损11例。男7例,女4例;年龄17～55岁,平均33.5岁。梳棉机损伤5例,车祸伤4例,受伤至手术时间90min～6h,平均3.5h;烧伤晚期上肢严重瘢痕挛缩畸形2例,受伤至手术时间分别为7个月和19个月。皮肤缺损范围42cm×12cm～60cm×16cm。术中切取皮瓣范围45.0cm×10.5cm～62.0cm×18.0cm,术后4周联合皮瓣断蒂。供区创面直接缝合7例,游离植皮修复4例。结果术后皮瓣均顺利成活,切口均Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮均成活。患者术后均获随访,随访时间为2个月～3年。皮瓣质地柔软、外形饱满、色泽正常。根据英国医学研究会评定标准,皮瓣感觉恢复:S1级4例,S2级6例,S3级1例。手部功能按照中华医学会手外科分会手功能评定试用标准综合评价:优7例,良2例,差2例,优良率81.8%。结论应用双髂腹股沟及腹部联合皮瓣修复前臂与手大面积皮肤缺损,操作简便,修复效果好,是一种较好方法。Objective To investigate an operative method of repairing large skin defect of the forearm and the hand. Methods From July 2003 to September 2008, 11 patients with large skin defect of the forearm and the hand were repaired using bilateral groin flaps in complex with abdominal flaps, including 7 males and 4 females aged 17-55 years old （average 33.5 years old）. Among the 11 cases, 5 were caused by carding machine and 4 by traffic accident, and the interval between injury and operation was 90 minutes to 6 hours （average 3.5 hours）; 2 cases suffered from severe cicatricial contracture deformity in the late stage of burn injury, and the interval between injury and operation was 7 months and 19 months, respectively. The size of skin defect ranged from 42 cm × 12 cm to 60 cm ×16 cm. The flaps harvested during operation was 45.0 cm× 10.5 cm - 62.0 cm ×18.0 cm in size. Pedicle division of the combined flaps was performed 4 weeks after operation. The donor site wound was repaired by direct suturing in 7 cases and by free skin grafting in 4 cases. Results All flaps survived. All incisions healed by first intention. The donor site wound all healed by first intention. Skin graft all survived. All patients were followed up for 2 months to 3 years. The flaps were soft in texture, full in contour, and normal in color. Sensory recovery of the flaps was evaluated according to the Criteria of UK Medical Research Council （1954）, 4 cases were in grade S1, 6 in grade S2, and 1 in grade S3. Hand function was assessed by the Criteria of Chinese Hand Surgery Society, 7 cases were graded as excellent, 2 as good, 2 as poor, and the excellent and good rate was 81.8%. Conclusion Combined use of bilateral groin flaps and abdominal flap is an effective approach to repair large skin defect of the forearm and the hand due to its simple operative procedure and satisfying effect.

关 键 词：前臂 手 皮肤缺损 腹股沟皮瓣 腹部皮瓣 创面修复 

分 类 号：R658.3[医药卫生—外科学]