手指皮肤逆行套状撕脱伤的显微手术回植  

Microsurgical replantation of retrograde avulsion injury of finger skin

作　　者：王军[1] 李红卫[1] 白晨平[1] 李大为[1] 王智茹[1] Wang Jun;Li Hongwei;Bai Chenping;Li Dawei;Wang Zhiru(Department of Hand Surgery,Zhengzhou Orthopedic Hospital,Henan 450052,China)

机构地区：[1]郑州市骨科医院手外科,河南450052

出　　处：《中华手外科杂志》2020年第2期92-94,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨手指皮肤逆行套状撕脱伤显微手术回植的临床效果。方法自2013年6月至2018年6月收治12例手指逆行套状撕脱伤患者,予修复骨折脱位、皮肤回植并修复血管、神经及肌腱,术后抗感染、抗凝血、抗痉挛,绝对卧床,保温,观察回植皮肤的血供、感觉及功能恢复情况。结果10例患者手指皮肤成活良好,2例手指少量皮肤坏死结痂,积极换药脱痂后伤口愈合良好。术后随访6~12个月,12例患者手部外形良好、皮肤质地柔软,血供充分,手指功能良好,根据手功能评定标准,指间关节及掌指关节屈伸功能总活动度与健侧比较,优7例,良2例,中3例。皮肤感觉恢复至S45例,S34例,S22例,S11例。结论手指皮肤逆行套状撕脱伤的显微手术回植,可降低撕脱皮肤的坏死几率,最大限度保留手指的外形与功能,是一种值得借鉴的方法。Objective To explore the clinical efficacy of microsurgical replantation of retrograde avulsion of finger skin.Methods From June 2013 to June 2018,12 cases of retrograde avulsion injury of fingers were treated by the repair of fracture dislocation,skin replantation and repair of blood vessels,nerves and tendons.After operation,anti-inflammatory,anticoagulant and antispasmodic treatment were performed.They were absolutely in bed and kept warm.The blood supply,sensation and functional recovery of replanted skin were observed.Results The skin of fingers survived well in 10 cases,and a small amount of skin necrosis and scab formed in 2 cases.The wound healed well after active dressing change and scab removal.The follow-up time ranged from 6 to 12 months.12 patients had good hand shape,soft skin,sufficient blood supply and good finger function.The total activity of flexion and extension of interphalangeal joint and metacarpophalangeal joint of the affected side were compared with those of the healthy side.According to the evaluation standard of hand function,the results were rated as excellent in 7 cases,good in 2 cases and fair 3 cases.The skin sensation recovered to S4 in 5 cases,S3 in 4 cases,S2 in 2 cases and S1 in 1 case.Conclusion The microsurgical replantation of retrograde avulsion of finger skin can reduce the necrosis rate of avulsion skin and retain the shape and function of finger to the maximum extent,which is a method worthy of reference.

关 键 词：指损伤 显微外科手术 逆行撕脱伤 回植 

分 类 号：R65[医药卫生—外科学]