腹部穿支瓦合皮瓣修复手部大面积皮肤套脱伤  

Repair of large-size degloving injury of the hand with epigastric perforator tile flap

作　　者：谭琪 刘光军 杨磊 王谦 李振 

机构地区：[1]解放军第八九医院骨科,潍坊261021

出　　处：《中华手外科杂志》2014年第5期341-344,共4页Chinese Journal of Hand Surgery

摘　　要：目的 探讨腹部带蒂穿支瓦合皮瓣修复手部大面积皮肤套脱伤的方法和临床效果.方法 以腹壁下动脉与腹壁上动脉和肋间动脉交通形成的轴型血管为解剖学基础,设计兔耳式腹部带蒂穿支瓦合皮瓣修复手部大面积皮肤套脱伤患者7例,均有手部掌侧和背侧的皮肤缺损.掌侧皮肤缺损大小为9 cm×8 cm～ 18 cm×9 cm,背侧皮肤缺损大小为8 cm×7 cm～ 14 cm×9 cm.皮瓣切取面积垂直向10 cm×6 cm～20 cm×9 cm,斜向9 cm×8 cm～22 cm×11 cm.供区均一期拉拢缝合.结果 7例患者术后随访5个月至2.5年,平均9个月.1例患者因掌侧皮瓣受压坏死.6例皮瓣均存活良好,外形、质地良好.基本恢复持物、抓握等功能,皮瓣感觉为S2～S3.结论 兔耳式腹部穿支瓦合皮瓣能够巧妙地覆盖手部掌侧、背侧大面积皮肤缺损,切取面积大,皮瓣血供来源可靠,能够最大程度地恢复患手功能,是一种实用、安全且简便的手术方式.Objective To investigate the surgical methods and clinical results of repairing large-size degloving injury of the hand with epigastric perforator tile flap.Methods The rabbit ear-shaped abdominal tile flap was designed based on the axial vessel formed by communications among the inferior epigastric artery,superior epigastric artery and intercostal arteries.Such abdominal tile flaps were transferred to cover skin defects on both the palmar and dorsal aspects of the hand in 7 cases of large-size degloving injury of the hand.The size of the defect ranged from 9 cm × 8 cm to 18 cm × 9 cm on the palmar aspect and 8 cm × 7 cm to 14 cm × 9 cm on the dorsal aspect.The size of the flaps ranged from 10 cm × 6 cm to 20 cm × 9 cm in the vertical direction and from 9 cm × 8 cm to 22 cm × 11 cm in the oblique direction.Direct wound closure of the donor site was possible in all the cases.Results All 7 cases were follow-up for 5 to 30 months （average,9 months）.Necrosis of the palmar flap occurred in 1 case due to compression to the flap.The rest 6 flaps survived uneventfully.The texture and appearance of the flaps were satisfactory.Grasp and pinch function was basically restored.Sensation of the flaps returned to S2 to S3.Conclusion Rabbit ear-shaped epigastric perforator tile flap can effectively cover large size defects on both palmar and dorsal aspects of the hand.It is sizable and has reliable blood supply,therefore can restore hand function to the maximum extent.It is also a practical,safe and simple procedure.

关 键 词：手 外科皮瓣 套脱伤 腹部皮瓣 

分 类 号：R658.2[医药卫生—外科学]