髂腹股沟复合组织瓣修复手足部皮肤软组织缺损的效果  

Effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot

作　　者：吴学仁 魏盼杰[2] 赵耀华[3] 李卫忠 王书立 段照品 刘昌 Wu Xueren;Wei Panjie;Zhao Yaohua;Li Weizhong;Wang Shuli;Duan Zhaopin;Liu Chang(Department of Orthopedics,Traditional Chinese Medicine Hospital of Zhongmu County of Henan Province,Zhengzhou 451400,China;Department of Orthopedics,Henan Armed Police Corps Hospital,Zhengzhou 450000,China;Department of Burns and Plastic Surgery,the Affiliated Jiangyin Hospital,Medical College of Southeast University,Jiangyin 214400,China)

机构地区：[1]河南省中牟县中医院骨科,郑州451400 [2]武警河南总队医院骨科,郑州450000 [3]东南大学医学院附属江阴医院烧伤整形科,214400

出　　处：《中华烧伤杂志》2020年第8期722-725,共4页Chinese Journal of Burns

摘　　要：目的探讨髂腹股沟复合组织瓣修复手足部皮肤软组织缺损并重建腕部、手指、踝部、足趾屈伸功能的效果。方法2012年2月-2018年3月,河南省中牟县中医院、武警河南总队医院、东南大学医学院附属江阴医院分别收治4、5、3例手足部皮肤组织缺损患者,其中男11例、女1例,年龄23~62岁,手部缺损5例、足部缺损7例。清创后皮肤软组织缺损面积10 cm×8 cm^15 cm×10 cm,根据缺损创面面积及肌腱缺损长度设计并切取髂腹股沟复合组织瓣,组织瓣面积为10 cm×8 cm^15 cm×12 cm。根据受区具体情况,组织瓣中旋髂浅动脉与受区尺动脉端侧吻合2例、端端吻合1例,与足背动脉端侧吻合4例,与胫后动脉端侧吻合2例,与足跗外动脉端端吻合1例;组织瓣中腹壁浅动脉与受区桡动脉端侧吻合1例,与尺动脉端端吻合1例。供瓣区直接拉拢缝合或移植大腿中厚皮修复。观察术后组织瓣成活情况,随访时组织瓣外观、质地、两点辨别觉距离等,并采用手部主动运动总和法进行手部功能评定,按Maryland足部评分标准进行足部功能评定。结果12例患者组织瓣均成活。术后随访6~36个月,组织瓣略显臃肿,与受区结合处有线状瘢痕,组织瓣两点辨别觉距离为15~22 mm;手部功能评定为优3例、良1例、可1例,足部功能评定为优4例、良2例、可1例;患者对手足功能恢复及外观满意。结论髂腹股沟复合组织瓣可修复手足部创面并重建腕部、手指、踝部、足趾的屈伸功能,是修复该类缺损的有效方法。Objective To explore the effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot and reconstructing the flexion and extension functions of wrist,finger,ankle,and toe.Methods From February 2012 to March 2018,4,5,and 3 patients(11 males and 1 female,23-62 years old)with skin and soft tissue defects on hand or foot were admitted to Traditional Chinese Medicine Hospital of Zhongmu County of Henan Province,Henan Armed Police Corps Hospital,and the Affiliated Jiangyin Hospital of Medical College of Southeast University,respectively.Five patients had hand defects,and 7 patients had foot defects.The areas of skin and soft tissue defects after debridement were 10 cm×8 cm-15 cm×10 cm.The ilioinguinal composite tissue flaps were designed and resected according to the wound area and the length of tendon defects,and the areas of flaps were 10 cm×8 cm-15 cm×12 cm.According to the specific condition of the recipient area,the superficial iliac circumflex artery in the tissue flap was reconstructed by end-to-side anastomosis in 2 patients and end-to-end anastomosis in 1 patient with ulnar artery,end-to-side anastomosis in 4 patients with the dorsal foot artery,end-to-side anastomosis in 2 patients with the posterior tibial artery,and end-to-end anastomosis in 1 patient with the external tarsal foot artery in the recipient area,and the superficial epigastric artery in the tissue flap was reconstructed by end-to-side anastomosis in 1 patient with the radial artery and end-to-end anastomosis in 1 patient with the ulnar artery in the recipient area.The donor sites were sutured directly or repaired with medium split-thickness skin grafts.The survival of tissue flap after the operation and the appearance,texture,and the two-point discrimination distance of the tissue flaps during follow-up were observed.The hand function and foot function were evaluated by the total active movement standard of hand and the Maryland foot score standard,respectively.Results All the tissue flaps in 12 p

关 键 词：手 足 髂腹股沟皮瓣 腹外斜肌腱膜 皮肤软组织缺损 肌腱缺损 

分 类 号：R644[医药卫生—外科学] R61[医药卫生—临床医学]