踝前联合足背皮瓣游离重建手掌贯通伤  

Repairment of skin defects of penetrating palm wound by application of free string-type dorsalis pedis flap

作　　者：刘春娟[1] 翟瑞华[1] 张明英[1] 王建国 

机构地区：[1]潍坊市益都中心医院手足外科,山东省潍坊市262500 [2]青州市中医院骨科

出　　处：《中华显微外科杂志》2017年第5期460-463,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨采用踝前联合足背皮瓣游离重建手掌贯通伤致皮肤缺损的临床疗效。方法2011年5月至2017年1月，采用踝前联合足背皮瓣游离移植重建手掌部贯通伤致皮肤缺损16例，足背皮瓣切取范围：5.0 cm×3.0 cm^8.0 cm×6.0 cm；踝前皮瓣切取范围：3.0 cm×2.0 cm^7.0 cm×5.0 cm。观察患者术后皮瓣成活状况、色泽、外形、感觉及手掌功能恢复状况、供区有无影响等。结果本组16例32块皮瓣均成活，术后随访2个月~2年，手部外形满意，皮瓣质地柔软，两点分辨觉达6~8 mm，骨折处完全愈合，手指运动TAM达健侧的75%。根据中华医学会手外科学分会手功能评定试用标准综合评价：优8例，良5例，可2例，差1例。优良率为81.25%。结论踝前与足背皮瓣血管解剖位置固定，手术切取方法简单，一次手术可以同时修复手掌及手背两处皮肤缺损，采用踝前联合足背皮瓣游离移植重建手掌部贯通伤获得较好的临床效果，疗效满意。ObjectiveTo investigate the clinical outcome of the feasible method of the free string type dorsalis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm.MethodsFrom May, 2011 to January, 2017, the anterior combined ankle flap of the ankle were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.ResultsAll 32 flaps in the 16 cases survived. Follow-up were done from 2 months to 2 years after operation. Bone healing was achieved in all cases. Two-point discrimination recovered to 6-8mm. Total active range of motion of the fingers reached 75% of the normal side. Both appearance and texture of the flaps were good. Both the appearances of the repaired palms and the functional recovery were satisfactory. The function assessment of the hand was excellent in 8 cases, good in 5 cases, fine in 2 cases and poor in 1 case. The eligible rate was 81.25%.ConclusionThe anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant, which facilitate the dissection of the flaps during operation. The repairement of skin defects at two sides, both the palm and the back of hand, can be achieved via one operation. Therefore, the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm.

关 键 词：踝前皮瓣 足背皮瓣 手掌贯通伤 重建 

分 类 号：R658.2[医药卫生—外科学]