股前外侧及髂腹股沟联体皮瓣急诊修复上肢超长复合组织缺损疗效观察  

ANTEROLATERAL THIGH AND GROIN CONJOINED FLAP FOR EMERGENT REPAIR OF ULTRA-LONG COMPLEX TISSUE DEFECTS IN FOREARM AND HAND

作　　者：王茂荣 谷云峰 陈福生 李军 王江宁[3] 尹叶锋[3] 

机构地区：[1]河曲县人民医院骨科,山西河曲036500 [2]温州手足外科医院手外科 [3]首都医科大学北京潞河医院整形与修复重建外科

出　　处：《中国修复重建外科杂志》2013年第8期1010-1014,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用股前外侧及髂腹股沟联体皮瓣急诊修复上肢超长面积复合组织缺损的疗效。方法 2009年2月-2011年10月,收治6例前臂背侧及手背超长面积复合组织缺损患者。其中男5例,女1例;年龄32～47岁,平均38.5岁。致伤原因:机器伤5例,交通事故伤1例。损伤至入院时间3～16 h,平均6.8 h。均为单侧肢体损伤,其中右侧4例,左侧2例。创面范围36 cm×9 cm～48 cm×12 cm。合并肘关节开放损伤并桡骨头骨折脱位2例,尺、桡骨及掌骨骨折4例。腕关节背侧皮肤及伸指、伸腕肌腱缺损5例,尺动脉、尺神经缺损1例。急诊采用大小为36 cm×9 cm～48 cm×12 cm的股前外侧及髂腹股沟联体皮瓣游离移植修复,同时行部分功能重建。供区植皮修复。结果术后1例发生皮瓣血管蒂与骨间背动脉吻合口栓塞,1例皮瓣下出现脓性分泌物,均经对症处理后愈合。其余患者皮瓣均顺利成活,创面Ⅰ期愈合。供区植皮中2例全部成活,切口Ⅰ期愈合;4例下腹部植皮部分坏死,经换药后愈合。患者均获随访,随访时间3～18个月,平均10个月。皮瓣外形、质地良好。2例随访达14个月以上患者,皮瓣恢复保护性感觉;其余患者皮瓣均未恢复感觉。末次随访时,手功能按中华医学会手外科学会上肢部分功能评定试用标准评定:获优1例,良4例,差1例,优良率83.3%。结论应用股前外侧及髂腹股沟联体皮瓣游离移植修复前臂背侧及手背超长面积复合组织缺损,可获良好近期疗效。Objective To evaluate the effectiveness of anterolateral thigh and groin conjoined flap in emergent repair of ultra-long complex tissue defects in forearm and hand. Methods Between February 2009 and October 2011,6 patients with complex tissue defect of dorsal forearm and hand were in adminsion.There were 5 male and 1 female with an average age of 38.5 years（range,32-47 years）.Injury reasons included machine injury in 5 cases and traffic accident injury in 1 case.Injury to admission time was from 3 to 16 hours（mean,6 hours）.All case were single limb injury,including right forearm and hand injury in 4 cases and left forearm and hand injury in 2 cases.The wound area was from 36 cm × 9 cm to 48 cm × 12 cm.The type of associated injury included elbow dislocation associated with open injury in 2 cases;fractures of the radial,ulnar,and metacarpal bone in 4 cases;defects of wrist dorsal skin and extensor tendons of fingers and wrist in 5 cases;and defects of ulnar artery and ulnar nerve in 1 case.The anterolateral thigh and groin conjoined free flaps were used to repair defects in the forearm and hand in emergency.The area of flap was from 36 cm × 9 cm to 48 cm × 12 cm.Meanwhile the partial functional reconstruction was performed.The donor site was repaired by skin grafts. Results The anastomotic embolization of vascular pedicle and arteria interossea dorsalis occurred in 1 case,purulent secretion under the flap in 1 case,which were cured after symptomatic treatment;the skin flaps completely survived,and primary healing of the wounds were obtained in the other cases.The donor skin grafts survived in 2 cases,and partial necrosis of the skin graft of lower abdominal occurred in 4 cases,and healed after changing dressing.All of the 6 patients were followed up 3 to 18 months（mean,10 months）.The appearance and texture of the flaps were good.The protective sensation was recovered in 2 cases followed up for more than 14 months;no sensory recovery was observed in the other cases.At last follow-up,according to the

关 键 词：股前外侧皮瓣 髂腹股沟皮瓣 联体皮瓣 创面修复 

分 类 号：R658.2[医药卫生—外科学]