手指皮肤脱套伤静脉动脉化修复的临床应用  

Application of venous arterialization for repairing avulsion injury of finger

作　　者：梁伟强 徐亚非 伍美艺 曾国师 张德军 李冠军 曾辉 

机构地区：[1]南海区第三人民医院手足外科,广东佛山528244

出　　处：《实用手外科杂志》2013年第3期309-310,315,共3页Journal of Practical Hand Surgery

基　　金：基金项目：广东省佛山市科技局医学类科技攻关项目（200908133）

摘　　要：目的探讨无指固有动脉存留的手指皮肤脱套伤静脉动脉化修复的临床效果。方法在脱套手指皮肤侧方纵行切开．摊开皮肤呈一块状游离皮瓣，找到两条主干静脉，标识。在10倍手术显微镜下，先将皮瓣脂肪大部分清除，保留皮瓣的真皮下血管网，再显露并切断两条主干静脉之间的交通支，脱套手指皮肤原位回植，皮肤的一条静脉远端或近端与伤指的指固有动脉吻合，另一端结扎；另一条静脉近端与指背静脉吻合．临床应用5例。结果本组5例术后0．5～3h皮肤出现毛细血管反应，4-6h变红润，之后未出现皮色暗紫、严重肿胀。其中2例顺利成活；2例术后3d有皮肤肿胀、瘀血明显，经远端小切口放血3～5d后好转并全部成活：1例部分坏死．经换药后植皮愈合。成活的皮肤随访3个月～1年，皮肤质地柔软，弹性、耐磨性好，色泽稍暗，皮肤两点辨别觉4～10mm。结论静脉动脉化修复无指固有动脉存留的手指皮肤脱套伤临床效果良好。Objective To evaluate the treatment effect of repairing the avulsion injury of finger skin which without proper palmar digital artery by venous arterialization. Methods Take a lateral incision in the skin of finger, found two main veins and marked them. First, got rid of the most of the fat in the flaps by the 10x surgical microscope, retained the dermal vascular network of the flaps. Second, implanted the skin of the finger in situ, showed and cut off the traffic branch between the two main veins. Then made an anastomosis of the distal or proximal end of the vein with the proper palmar digital artery, and ligatured the other end at the same time. Third, made an anastomosis of the proximal end of the other vein with the digital dorsal vein. 5 cases in clinical were applied. Results 5 cases appeared capillary reaction in 0.5-3 h after the operation, and become ruddy in 4-6 h after the operation but never appeared mulberry or severe swelling. 2 cases of them survived smoothly, 2 cases appeared swelling and gore after 3 d, but become well and survived both after bloodletting at the distal of the finger with small incision.The partial necrosis of the skin which was repaired appeared in 1 case of them, but healed by the surgery of skin grafting after dressing change. The skin of all the cases which were repaired were followed up for 3 months to 1 year. They were soft and elasticity. Their abrasion resistance was good, their color was a little dark, and the discrimination of two-point ranged from 4mm to 10mm. Conclusion It is an effective and reliable method, that using venous arterialization for repairing the avulsion injury of finger skin, which without proper palmar digital artery.

关 键 词：手损伤 脱套伤 静脉皮瓣 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]