手指皮肤缺损显微外科修复的方法及疗效  

Clinical methods and effects of microsurgical repair of finger skin defect

作　　者：卢建国[1] 杨庆达[1] 苏瑞鉴[1] 梁波[1] 梁大喜[1] 

机构地区：[1]贵港市中西医结合骨科医院创伤科,广西贵港537100

出　　处：《临床骨科杂志》2015年第5期598-601,共4页Journal of Clinical Orthopaedics

摘　　要：目的：分析手指皮肤软组织缺损显微外科修复的方法及临床疗效。方法对200例皮肤软组织缺损患者（320指）采用掌背动脉穿支蒂营养皮瓣、手背皮神经营养皮瓣、指动脉逆行岛状营养皮瓣、示指背皮瓣、邻指皮瓣、桡动脉鼻烟窝上行穿支逆行皮瓣（简称鼻咽窝皮瓣）、改良交腹皮瓣、改良第一趾蹼游离皮瓣等方法修复。结果术后197例（316指）皮瓣成活,3例（4指）皮瓣部分坏死,经换药后愈合。128例（215指）获得随访,时间6~60个月。患指皮瓣外形良好,无瘢痕挛缩畸形,吻合神经的皮瓣感觉恢复良好,两点辨别觉4~8 mm,功能恢复良好。参照中华医学会手外科学会上肢部分功能评定试用标准：优87例（157指）,良32例（45指）,差9例（13指）,优良率93．0%。结论掌背动脉穿支蒂营养皮瓣、手背皮神经营养皮瓣、示指背皮瓣、指动脉逆行岛状营养皮瓣、鼻咽窝皮瓣能一次性修复创面,吻合神经的皮瓣感觉恢复良好。邻指皮瓣、改良交腹皮瓣需要二期断蒂或分指,增加了手术次数,同时患肢长时间制动,易引起关节僵硬等,但腹部皮瓣能切取的皮瓣面积较大,对于多指软组织缺损能一次性覆盖。改良第一趾蹼游离皮瓣能一次性修复缺损创面,不需要二期整形,吻合神经后感觉恢复良好,但对显微外科技术有很高的要求,不易在基层医院推广。Objective To summarize the clinical curative effect and methods of microsurgical repair of finger skin and soft tissue defect. Methods 200 patients （320 fingers） of skin and soft tissue defect were repaired by using the ar-teriole metacarpeae dorsales perforator pedicle nutritional flap, the curtaneous nerve dorsum of hand nutritional flap, the arteria digitals reverse island nutritional flap,the index finger dorsal flap,the cross finger flap, and the arteria ra-dialis tabatiere anatomique uplink perforator reverse flap （ hereinafter referred as tabatiere anatomique flap） ,the im-proved hand abdominal flap and the improved the first toe web free skin flap and so on. Results Excerpt 3 cases （4 fingers） were suffered with partial flap necrosis and cicatrized after changing dressing, 197 cases（316 fingers） were survived. 128 cases （215 fingers） achieved follow-up. The time of follow-up was 6~60 months. All the follow-up patients′flaps were good in shape and had no dysmorphia of scar contracture. The dialyneurg flap sensation and func-tion got right. The two point discrimination was 4~8mm. According to the criteria by Society of Hand Surgury of Chi-nese Medical Association, the results were excellent in 87 cases （157 fingers）,good in 32 （45 fingers）,and poor in 9 （13 fingers）,and the excellent and good rate was 93. 0%. Conclusions The arteriae metacarpeae dorsales perfo-rator pedicle nutritional flap, the curtaneous nerve dorsum of hand nutritional flap,the index finger dorsal flap, the ar-teria digitals reverse island nutritional flap and the tabatiere anatomique flap can repair wound in the first operation and the dialyneury flap sensation get right. The cross finger flap and the improves hand abdominal flap need to do the second operation to cup the pedicle or separate finger. This method adds operation times and get anchylosis more easi-ly, because the affected extremity are exercise limit so long. But the abdominal flap can cover all fingers soft tissue defect in the first times

关 键 词：指损伤 皮瓣 修复 显微外科 

分 类 号：R622.12[医药卫生—整形外科] R658.2[医药卫生—外科学]