吻合血管回植术治疗全手皮肤套脱伤  

Replantalion surgery with vascular anastomosis for treating whole hand degloving injury

作　　者：巨积辉[1] 李建宁[1] 李祥军[1] 熊胜[1] 周荣[1] 李秀平[1] 王盛福[1] 侯瑞兴[1] 

机构地区：[1]苏州大学附属瑞华医院手外科,苏州215104

出　　处：《中华手外科杂志》2012年第4期218-220,共3页Chinese Journal of Hand Surgery

基　　金：苏州市社会发展应用基础研究资助项目（SYSD2010101）

摘　　要：目的报告吻合血管回植术治疗全手皮肤套状撕脱伤的手术方法和临床疗效。方法对19例全手皮肤套脱伤患者，采用吻合血管的回植术，将套脱皮肤进行回植，手掌、背皮肤予轻轻加压包扎。结果术后5例回植套脱皮肤完全成活；2例1—5指、手掌及手背皮肤全部坏死，再次行1—5指近节截指、腹部皮瓣修复术；6例部分手指坏死，行截指术；6例手掌或手背部分皮肤坏死，二次行皮瓣修复术。术后随访时间为6～84个月，5例套脱皮肤完全成活者，手指屈伸、抓捏等功能恢复满意；2例完全坏死者，手功能完全丧失；其余患者恢复部分手功能。手指感觉恢复至s2～s4，手掌、背部皮肤感觉恢复至S1-S3。结论采用吻合血管的回植术治疗全手皮肤套脱伤，只要掌握好手术适应证，可以获得满意的疗效。Objective To report the surgical techniques and clinical efficacy of replantafion surgery with vascular anastomosis for treating whole hand degloving injury. Methods Nineteen cases of whole hand degloving injury were treated with replantation combined with vascular anastomosis. The degloved skin was attached back and the skin of the palm and back of the hand was given light compression bandage. Results Complete survival of the replanted degloved skin was seen in 5 cases. Two cases experienced complete necrosis in 1 to 5 fingers and the skin of the palm and back of the hand. Amputation of five digits from the proximal phalangeal level and abdominal flap for coverage of the palm and dorsum of the hand were done. In 6 cases, partial necrosis in the fingers oceurred and these fingers were amputated. In another 6 cases, partial skin necrosis occurred in the palm or the back of the hand and another repair surgery with skin flap was carried out. After 6 to 84 months＇ follow-up, for 5 cases with complete survival, the hand function such as flexion and extension was satisfactory. For two cases with complete necrosis, the hand function was completely lost. For the other cases, the function of the hand was partially recovered. Sensory recovery in the fingers ranged S2 to S4 and sensory recovery from S1 to S3 was achieved in the skin of the palm and back of the hand. Conclusion Satisfactory therapeutic effect can be obtained when using replantation surgery with vascular anastomosis for treating whole hand degloving injury as long as the surgical indications were appropriate.

关 键 词：手损伤 显微外科手术 套脱伤 回植 

分 类 号：R658.2[医药卫生—外科学]