游离螺旋形穿支皮瓣修复拇指完全套脱伤  

Spiral free perforator flaps for completely degloved thumb reconstruction

作　　者：池征璘[1] 李赞[2] 宋达疆[2] 

机构地区：[1]温州医科大学第二附属医院手外科,325027 [2]湖南省肿瘤医院肿瘤整形外科

出　　处：《中华创伤杂志》2017年第2期123-128,共6页Chinese Journal of Trauma

基　　金：湖南省自然科学基金面上项目（13JJ5012）;湖南省科技计划项目（2014SK3002）

摘　　要：目的评价游离螺旋形穿支皮瓣修复拇指完全套脱伤的效果。方法采用回顾性病例系列研究分析2009年6月-2014年12月应用不同来源的穿支皮瓣以螺旋形术式修复22例拇指完全套脱伤患者的临床资料，其中男19例，女3例；年龄18—46岁，平均27．8岁。修复方法包括臂内侧穿支皮瓣13例，切取皮瓣面积为8．0cm×3．0cm-14．5cm×3．5cm，另外9例采用腓动脉穿支皮瓣游离移植，切取皮瓣面积为6．0cm×3．5cm-21．0cm×10．0cm。术后随访修复手指感觉、功能、外形及皮瓣供区恢复情况。结果22例皮瓣均完全成活，术后无血管危象和感染发生，仅有1例臂内侧穿支皮瓣和1例腓动脉穿支皮瓣远端血运轻度障碍，非手术治疗后成活良好，拇指外观和功能恢复良好。平均术后随访14．5个月（9-22个月），皮瓣两点辨别觉恢复至6-13mm，未遗留线性挛缩瘢痕。所有供区创面均I期愈合，感觉功能无明显影响，患者总体满意度较高。结论游离螺旋型穿支皮瓣可有效避免线行瘢痕挛缩的发生，最大限度减小供区损伤，外观功能恢复更满意，是修复拇指套脱伤的较好选择。Objective To determine the effect of resurfacing completely degloved thumbs by free perforator flaps in a spiral fashion. Methods A retrospective case series study was made on 22 patients with completely degloving injury of the thumb treated by different free perforator flaps in a spiral fashion from June 2009 to December 2014, including 19 male and 3 female patients at the age of 18-46 years （mean, 27. 8 years）. A total of 13 patients were reconstructed using the medial arm perforator flaps ranging in size from 8.0 cm × 3.0 cm-14.5 cm ×3.5 cm, and 9 patients were reconstructed using the peroneal artery perforator flaps ranging in size from 6.0 cm × 3.5 cm-21.0 cm× 10.0 cm. Follow-up was made to evaluate the sensation, appearance and function of the thumbs and the recovery of flap donor sites. Results All flaps survived completely, with no occurrence of postoperative vascular crisis and infection. Only one medial arm flap and one soleus perforator flap distal flap showed blood flow disorder in the distal sections and were healed uneventfully after conservative therapy. Function and cosmetic recovery of the reconstructed thumbs were good. Follow-up ranged from 9 to 22 months （mean, 14. 5 months）. Two- point discrimination test of the flaps was recovered to 6-13 mm. No linear scar contracture was left. Flap donor site wound healed primarily. All patients were satisfied with the overall results. Conclusion The free perforator flap in a spiral fashion can avoid linear scar contracture, maximally decrease donor site morbidity and achieve satisfactory functional recovery and good aesthetic restoration, indicating a good candidate for reconstruction of thumb degloving injury.

关 键 词：拇指 指损伤 游离穿支皮瓣移植 

分 类 号：R658.2[医药卫生—外科学]