游离静脉皮瓣动脉化修复手指离断伤伴皮肤软组织缺损12例  

Repair of 12 cases of finger mutilation complicated with skin and soft tissue defects by free venous flap arterialization

作　　者：陈彦名[1] 谢松林[1] 许云华[1] 

机构地区：[1]南华大学附属南华医院手足外科,湖南衡阳421002

出　　处：《中国现代医生》2016年第32期59-61,共3页China Modern Doctor

摘　　要：目的 探讨应用静脉皮瓣动脉化急诊一期修复离断手指伴皮肤软组织缺损的临床效果。方法 选择2014年9月-2015年8月我科收治的12例手指离断并伴有皮肤软组织缺损的患者,采用手指再植同时切取同侧前臂游离静脉皮瓣修复手指皮肤软组织缺损：根据缺损部位吻合血管选择动脉-静脉-动脉吻合方式,将皮瓣内静脉干的远端与离断指远端动脉吻合,静脉干的近端与离断指近端吻合。出院后随访全部患者,间隔3个月/次,共12个月,并进行评估。结果 出院时12例患指术后皮瓣及手指均成活,皮瓣质地、色泽与手指正常皮肤相似,皮瓣无臃肿,供区伤口Ⅰ期愈合;出院后随访全部患者12个月：患指未见明显萎缩,基本感觉均已恢复,能正常持物,按中华医学会手外科学会断指再植功能评定试用标准各指均为优。结论 应用游离动脉化静脉皮瓣一期修复手指离断伤伴皮肤软组织缺损是一种实用、有效的术式,值得临床推广应用。Objective To report the clinical effect of stage I repair of mutilated finger complicated with skin and soft tissue defects by using venous flap arterialized emergency. Methods 12 patients with finger mutilation complicated with skin defects who were treated in our department from September 2014 to August 2015 were selected. They were given finger replantation and ipsilateral forearm free venous flap was collected to repair finger skin and soft tissue defects; according to the vascular anastomosis of the defect site, arterial-venous-arterial anastomosis was selected. The distal end of the venous trunk in the flap was anastomosed with the distal artery of the mutilated finger, and the proximal end of the venous trunk was anastomosed with the proximal end of the mutilated finger. All patients were followed up at the time of discharge from the hospital, at an interval of 3 months for a total of 12 months. They were then assessed. Results After the surgery for 12 cases of fingers, flaps and fingers were survived upon discharge. Flap texture,color and finger were similar to the normal skin. Flap were not bloated. Stage I wound healing at donor site was observed; all patients were followed up for 12 months after discharge： no significant atrophy of the fingers was observed,the basic feeling had been recovered, and the fingers were able to hold objects normally. According to the trial standard of evaluation of the function of replanted finger by The Chinese Society for Surgery of the Hand, all the fingers were evaluated as excellent. Conclusion The application of stage I repair of mutilated finger complicated with skin and soft tissue defects by using free venous flap arterialization is a practical and effective procedure, which is worthy of clinical promotion and application.

关 键 词：静脉皮瓣动脉化 断指 再植修复 皮肤软组织缺损 

分 类 号：R658.1[医药卫生—外科学]