游离组织移植修复前臂软组织缺损的临床研究  

Free tissue transplantation for repairing large soft tissue defects in the forearm： a clinical study

作　　者：王彦生[1] 张辉[1] 沈勇[1] 于宁[1] 谭润[1] 许蕙[1] 叶放[1] 

机构地区：[1]沈阳医学院附属中心医院手外科,110024

出　　处：《中华手外科杂志》2014年第3期203-205,共3页Chinese Journal of Hand Surgery

摘　　要：目的报告应用第二足趾复合组织瓣、股前外侧皮瓣、背阔肌肌皮瓣、胸脐皮瓣等四种游离组织，移植修复伴有深部组织损伤的手及前臂大面积软组织缺损的方法和临床效果。方法对46例外伤致伴有深部组织损伤的手及前臂大面积软组织缺损的患者，采用4种游离皮瓣移植修复。其中行第二足趾复合组织瓣4例、股前外侧皮瓣19例、背阔肌肌皮瓣15例、胸脐皮瓣8例。结果术后44例皮瓣全部存活，成功率为95．7％，2例失败。29例因皮瓣臃肿行皮瓣、肌皮瓣修整术。术后37例获得随访，时间为3个月至11年，皮瓣质地、弹性、外观良好。11例应用背阔肌肌皮瓣修复前臂大面积软组织缺损并重建伸指功能，均已恢复了大部分伸指功能。4例应用第二足趾复合组织瓣移植再造拇指，其外形及手功能恢复良好，指腹两点分辨觉为6—8mm。结论游离皮瓣移植适宜修复合并深部组织损伤的手及前臂大面积软组织缺损。其中背阔肌肌皮瓣移植可重建部分伸、屈指功能，第二足趾复合组织瓣游离移植可同时修复拇指及前臂大面积软组织缺损，功能与外形优于其他方法。Objective To report the repair of large area soft tissue defects combined with deep tissue injury in the forearm and hand using second toe composite flap, anterolateral thigh flap, latissimus dorsi flap and thoraco-umbilical flap. Methods Four types of free flaps were transferred to repair large area soft tissue defects combined with deep tissue injury in the forearm and hand in 46 cases. There were 4 cases treated with second too composite flap, 19 with anterolateral thigh flap, 15 with latissimus dorsi flap and 8 with thoracoumbilical flap. Results Postoperatively complete flap survival was seen in 44 cases achieving a 95.7% successful rate. Debulking of the cutaneous flap or myocutaneous flap was done in 29 cases due to flap bulkiness. Postoperative follow-up was achieved in 37 eases ranging from 3 months to 11 years. The texture, elasticity and appearance of the flaps were good. Finger extension fimction was mostly restored in 11 patients of forearm large soft tissue defects who underwent latissimus dorsi myocutaneous flap for soft tissue coverage and finger extensor recoustruetion. Four thumbs that were reconstructed with second toe composite flap recovered good appearance and function. Twooint discrimination in the pulp was 6 to 8 mm. Conclusion Free tissue transplantation is suitable for repairing large area soft tissue defects combined with deep tissue injury in the forearm and hand. Latissimus dorsi myocutaneous flap can be used to reconstruct some finger flexor and extensor function. Second toe composite flap transfer can repair forearm large area soft tissue defects combined with thumb defect. The appearance and function achieved are better than other methods.

关 键 词：外科皮瓣 组织移植 前臂损伤 手损伤 

分 类 号：R658.2[医药卫生—外科学]