腕横纹部带蒂皮瓣在拇指近端离断再植中的应用  

Replanting the complex amputated thumb with the pedicled flap from the rasceta area

作　　者：黎章灿 郑大伟 齐伟亚 朱辉 石荣剑 寿奎水 Li Zhangcan;Zheng Dawei;Qi Weiya;Zhu Hui;Shi Rongjian;Shou Kuishui(Department of Handsurgery, Xuzhou Renci Hospital, Xuzhou, Jiangsu Province 221004, China;Department of Hand Surgery, Wuxi Hand Surgery Hospital, Wuxi, Jiangsu Province 214061, China)

机构地区：[1]徐州仁慈医院手外科,221004 [2]无锡手外科医院手外科,214061

出　　处：《中华显微外科杂志》2019年第1期13-16,共4页Chinese Journal of Microsurgery

基　　金：江苏省徐州市医学青年后备人才培养工程基金(2014018).

摘　　要：目的探讨应用腕横纹部带蒂皮瓣修复拇指近端离断再植时软组织缺损的手术方法和疗效。方法2015年3月至2017年3月收治12例复杂性拇指离断伤,患指近端指动脉均撕脱缺损,并伴软组织缺损,面积1.5 cm ×3.0 cm^5.5 cm ×7.0 cm。行拇指离断再植术后,应用桡动脉掌浅支蒂腕横纹皮瓣带蒂转移修复缺损的软组织,腕部供区创面直接缝合。术后门诊随访复查皮瓣成活情况。结果本组1例皮瓣术后出现静脉回流障碍,经拆除部分缝线后症状缓解,其余患指、皮瓣均顺利成活,供区切口I期愈合。随访12~18(平均13.5)个月,拇指及皮瓣外形满意,供区瘢痕不明显,拇指功能按中华医学会手外科学会拇、手指再造功能评定试用标准评定,获优8例,良3例,中1例。结论腕横纹部带蒂皮瓣血供可靠、手术简便,可同时重建缺损动脉及修复创面,是再植拇指近端离断再植后软组织缺损修复的新术式。Objective To explore the operative method and effect of replantation of complex severed thumb with the pedicled flap from the rasceta area.Methods From March,2015 to March,2017,12 cases of complicated thumb injury were treated by retrograde transfer flap pedicled with the superficial palmar branch of the radial artery.All digital arteries defective with soft tissue defect,the area was 1.5 cm×3.0 cm to 5.5 cm ×7.0 cm.The wound of the wrist donor site was sutured directly.Postoperative followed-up was performed to review if the flap survival.Results There was 1 case of venous reflux disorder.After removal of some sutures,the symptoms were relieved.All other fingers survived successfully,and the flap survived completely.The donor site incision healed at Ⅰ stage.The followed-up period was 12-18 (average,13.5) months.The appearance of the thumb and flap was satisfactory,and the scar in the donor site was not obvious.The thumb function was evaluated according to the evaluation standard of thumb and finger reconstruction function of the Chinese society of medical surgery.Eight cases were excellent,3 cases were good,and 1 case was medium.Conclusion The pedicled flap from the rasceta area has the advantages of simple operation and reliable blood supply.It can reconstruct the defect vessels and repair the wound at the same time.It is a new method for replantation of complicated severed thumb.

关 键 词：腕横纹皮瓣 断指 再植 显微外科技术 

分 类 号：R658.1[医药卫生—外科学]