多种皮瓣急诊修复手部大面积组织缺损  

Flap transfer for coverage of oversized soft tissue defect of hand in emergency surgery

作　　者：陈前永[1] 赵光勋[2] 王海峰[2] 吴健[2] 袁伟[2] 吴成如[2] 方健 

机构地区：[1]解放军第105医院骨二科,安徽合肥230031 [2]解放军第105医院显微骨科,安徽合肥230031

出　　处：《临床骨科杂志》2011年第2期129-131,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨应用多种皮瓣急诊修复手部大面积组织缺损的临床效果。方法对47例手部大面积组织缺损患者,根据手部软组织缺损的不同伤情选择不同皮瓣进行修复：游离股前外侧皮瓣16例,尺动脉腕上皮支逆行岛状皮瓣13例,带桡神经浅支筋膜蒂逆行岛状皮瓣6例,前臂骨间背动脉逆行岛状皮瓣12例。结果 47例皮瓣均成活,其中4例逆行岛状皮瓣远端部分颜色暗紫,出现水疱,予以活血、换药治疗后一期愈合。12例皮瓣臃肿,术后6个月行修整术。患者均获随访,时间2个月-5年。皮瓣色泽、质地良好,部分皮瓣感觉恢复,手部功能恢复良好。结论急诊手术选择合适皮瓣修复手部创面,避免指骨、肌腱坏死,可早期锻炼,有利于手部功能恢复。Objective To explore the effect of different flaps in repairing oversized soft tissue defect of hand.Methods 47 cases with massive hand soft tissue defects were treated with different flaps according to their injury conditions.Among these cases,16 cases were treated using free anterolateral thigh flap,13 cases using reverse antebrachial flap with carpal epithelial branch of ulna artery,6 cases using reverse antebrachial flap with superficial branch of radial nerve,and the rest 12 cases using reverse antebrachial flap with pedicle of the posterior interosseous artery.Results All flaps survived.Among the 4 cases using reverse antebrachial flap were found with dark purple colour at distal end,and water blister.But they all achieved single-stage concrescence after bandage change and vasodilation therapy.Among the 12 cases applied second modified operation for swelling after the first operation.The follow-ups ranging from 2 months to 5 years showed good colour and texture of the flaps.And flap′s partial sensation and hand function were recovered.Conclusions Choosing appropriate flap,avoiding necrosis of phalanx and tendon,and early functional exercise will contribute to hand functional recovery.

关 键 词：手外伤 组织缺损 皮瓣 修复 

分 类 号：R782.4[医药卫生—口腔医学]