接合神经的拇指背侧皮瓣修复拇指再植坏死后创面的临床疗效  

The clinical effects of thumb dorsal neurocutaneous flap on soft-tissue necrosis after thumb replantation

作　　者：孙长胜 苏波 李文君 张辉 张玲玲 王婷婷 钱英俊 SUN Changsheng, SU Bo, LI Wenjun, et al(Deparunent of Hand Surgery, Shanghai Zhongye Hospital, Shanghai, 201999, Chin)

机构地区：[1]上海中冶医院手外科,上海201999

出　　处：《实用手外科杂志》2018年第1期3-5,共3页Journal of Practical Hand Surgery

基　　金：上海市宝山区科委科技创新专项资金(项目编号:16-E-31);上海市宝山区卫生青年医学人才培养计划(项目编号:bswsyq-2015-B2)

摘　　要：目的探讨接合神经的拇指背侧皮瓣修复拇指再植坏死后创面的临床疗效。方法 2011年7月-2016年5月,应用接合神经的拇指背侧皮瓣修复拇指再植坏死后创面7例7指,创面大小为1.5 cm×1.2 cm^2.8 cm×2.5 cm,皮瓣大小为1.8 cm×1.5 cm^3.2 cm×2.8 cm,其中拇指桡背侧皮瓣5例,尺背侧皮瓣2例。拇指背侧供区4例直接缝合,其余3例取全厚皮片植皮。结果 7例皮瓣全部成活,1例出现皮瓣远端坏死,经换药后愈合,1例出现静脉危象,拆除部分缝线后缓解。随访3~12个月,皮瓣外观满意,两点辨别觉9~12 mm。结论接合神经的拇指背侧皮瓣修复拇指再植坏死后创面,手术操作简单,皮瓣成活率高,是修复拇指再植坏死后创面较为理想的方式。Objective To investigate the clinical results of thumb dorsal neurocutaneous flap on repairing soft-tissue necrosis after replantation. Methods From July 2011 to May 2017, we used thumb dorsal neurocutaneous flap to repair soft-tissue necrosis after replantation in seven patients （7 fingers）. The average size were 1.5 cm×1.2 cm-2.8 cm×2.5 cm in soft-tissue defects, and 1.8 cm×1.5 cm-3.2 cm×2.8 cm in flaps. Of those, five flap were from the radialis of thumb, and the rest of two were from ulnaris of thumb. The donor sites were covered with direct suture in 4 cases, skin grafting in 3. Results All of the flaps survived and had partial necrosis at the distal end of the flaps in 1 case which achieved secondary healing after dress changing. Venous crisis occurred in another one and was alleviated after the stitches had been removed. The follow up period was 3-12 months. The appearances were excellent, and two-point discrimination ranged from 9 to 12 mm. Conclusion The thumb dorsal neurocutaneous flap is an effective treatment method for soft tissue necrosis following replantation. The procedure is simple, the survival rate is high, it is an idea/way to repair soft tissue defects following thumb replantation.

关 键 词：拇指 指损伤 外科皮瓣 

分 类 号：R658.2[医药卫生—外科学]