急诊Flow—through带关节的第二足趾复合组织瓣移植修复手指复合组织损伤  

Emergency repair of the soft tissue defects of finger by transplantation of flow-through composite tissue flap with the joint from the second toe

作　　者：吴建龙 谢庆平[1] 唐林峰[2] 侯瑞兴[2] Wu Jianlong;Xie Qingping;Tang Linfeng;Hou Ruixing(Department of Hand Surgery,Zhejiang Provincial People＇s Hospital,People＇s Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院手外科,杭州310014 [2]苏州大学附属瑞华医院骨科

出　　处：《中华手外科杂志》2018年第5期322-325,共4页Chinese Journal of Hand Surgery

基　　金：江苏省自然科学基金（BK20151203）

摘　　要：目的探讨急诊Flow—through携带近趾间关节的第二足趾复合组织瓣移植修复手指复合组织损伤的临床疗效。方法自2009年3月至2016年2月，我院对12例15指伴有近指问关节缺损的手指复合组织损伤患者，急诊应用Flow—through带关节的第二足趾复合组织瓣修复。所切取复合组织瓣中携带皮瓣面积15mm×10mm-40mm×35mm，携带骨关节长度20～42mm、平均28mm，携带趾同有动脉长度26～38mm、平均30mm，携带趾同有神经长度22，40mm、平均28mm。结果15指游离复合组织全部存活，伤口均Ⅰ期愈合。术后随访8—30个月，移植骨关节均骨性愈合，未出现退行性变及骨不连，除2例轻度欠伸，余关节均活动良好。手指近指间关节屈曲40°～90°、平均65°，伸-10°-10°。指体血供良好，指端两点分辨觉6—12mm。患者对手指外形及功能恢复满意。按中华医学会手外科学会手部功能评定标准评定：优5指，良8指，可1指，差1指。结论急诊应用Flow—through带近趾间关节的第二足趾复合组织瓣移植修复伴关节缺损的手指复合组织缺损，能够恢复较好的手指关节功能，同时重建远端指体血供及感觉，满足患者基本生活需求，是修复手指复杂损伤的较理想方法之一。Objective To evaluate the clinical efficacy of transplantation of flow-through composite tissue flap with the joint from the second toe for emergency repair of the soft tissue defects of finger. Methods From March 2009 to February 2016, 12 cases （15 fingers） of finger composite tissue defects with proximal interphalangeal joint defects were treated by transplantation of flow-through composite tissue flap with the joint from the second toe. The area of the composite tissue flap was 15 mm×10 mm to 40 mm×35 mm. The length of the bone joint was 20 to 42 mm with an average of 28mm. The length of the proper digital artery was 26 to 38 mm with an average of 30 mm. The length of the proper digital nerve was 22 to 40 mm with an average of 28 mm. Results All the composite flaps of the fingers survived and the wounds achieved primary healing. The follow-up period ranged from 8 to 30 months. The transplanted joints were healed without any degenerative changes or nonunion. Except for 2 cases with mild hypoextension, rest joints were all well-moved. The flexion of the proximal interphalangeal joint of the fingers ranged from 40° to 90° with an average of 65°, and the extension ranged from -10° to 10°. The blood supply of the finger was good, and the two-point discrimination of the fingertip was 6 to 12mm. The patients were satisfied with the appearance and function of the fingers. According to the hand function evaluation standard issued by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 5 fingers, good in 8 fingers, fair in 1 finger and poor in 1 finger. Conclusion The application of flow-through composite tissue flap of the second toe with interphalangeal joint transplantation for emergency repair of the finger complex tissue defects with joint defects can restore good finger joint function, and reconstruct the blood supply and sensation of the distal finger. It can meet the basic living requirement of the patient, which is one of the ideal methods to repair complicated i

关 键 词：指损伤 外科皮瓣 关节移植 复合组织 

分 类 号：R658.2[医药卫生—外科学]