多叶连体股前外侧穿支皮瓣一期修复手背合并多指指背软组织缺损  

One stage repair of dorsum of hand and multiple fingers soft tissue defect with polyfoliate conjoined anterolateral thigh perforator flap

作　　者：赵国红 魏鹏飞 孙华伟 张建华 谢振军 梁正洋 白辉凯 赵建军 冯帅 ZHAO Guohong;WEI Pengfei;SUN Huawei;ZHANG Jianhua;XIE Zhenjun;LIANG Zhengyang;BAI Huikai;ZHAO Jianjun;FENG Shuai(Department of Hand,Foot and Microsurgery,People's Hospital of Zhengzhou University(Henan Provincial People's Hospital),Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院(河南省人民医院)手足显微外科,郑州450003

出　　处：《中华显微外科杂志》2020年第6期553-557,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨应用游离削薄多叶连体股前外侧穿支皮瓣(ALTP)一期修复手背合并多指指背软组织缺损的手术方法及临床效果。方法2015年11月至2019年9月,共收治手背合并多指指背软组织缺损9例,其中男8例,女1例。年龄18~50岁,平均32岁。致伤原因:热压伤4例,绞压伤3例,车祸伤2例。受伤部位:右手7例,左手2例;手背合并第1~4指3例,第2~5指3例,第2~4指2例,第3~5指1例,均伴有骨、关节和肌腱外露。合并有骨折或关节脱位6例,均无明显骨和关节缺损,清创后均采用VSD敷料覆盖。所有皮瓣均根据创面的形状和大小设计成多叶连体ALTP,一期修复手背及指背软组织缺损,同时将皮瓣修薄。皮瓣大小7 cm×13 cm^12 cm×17 cm。术后定期门诊、电话和微信随访,根据皮瓣成活情况、外观形态、色泽弹性、供区瘢痕、感觉恢复、患指功能恢复情况、患者满意度等情况进行综合评价。结果本组9例皮瓣术后完全成活。术后随访6~18个月,平均12个月。皮瓣外形良好,不臃肿,质地柔软,恢复了保护性触觉。供区创面愈合良好,功能无影响。末次随访参照中华医学会手外科学会上肢部分功能评定试用标准:优5例,良3例,可1例。手功能恢复满意,术后平均6周回归工作和日常生活。结论应用修薄的多叶连体ALTP可以一次性修复手背合并多指指背软组织缺损,皮瓣外形良好,不臃肿,无需再次分指及皮瓣修整,是较为理想的方法之一。Objective To investigate the surgical method and clinical effect of one-stage repair of soft tissue defects of dorsum of hand and multiple fingers by using the polyfoliate conjoined anterolateral thigh perforator flap(ALTP).Methods From November,2015 to September,2019,9 cases of soft tissue defects of dorsum of hand and multiple fingers were treated,including 8 males and 1 female.The average age was 32 years old.Causes of injury:4 cases of thermal injury,3 cases of strangulation injury,and 2 cases of traffic accident injury.Location of injury:7 cases of right hand,2 cases of left hand.Three cases of dorsum of hand with 1st-4th fingers,3 cases with 2nd-5th fingers,2 cases with 2nd-4th fingers,and 1 case with 3rd-5th fingers;All with bone,joint and tendon exposure.There were 6 cases with fracture or joint dislocation.All of them had no obvious defect of bone and joint.VSD was used to cover them after debridement.According to the shape and size of the wound,all flaps were designed to repair the soft tissue defect as the polyfoliate conjoined ALTP.The flap size was 7 cm×13 cm-12 cm×17 cm.Regular outpatient,telephone and Wechat follow-up were carried out to evaluate the flap survival,appearance,color elasticity,donor scar,sensory recovery,finger function recovery and patient satisfaction.Results Nine cases of flap survived well.The average followed-up time was 12(6-18)months.The postoperative followed-up revealed satisfactory shapes of the flaps,protective touch and recovery of functions.The donor site had good healing and no effect on function.In the last followed-up,according to the trial criteria for function evaluation of upper limbs by Chinese Society of Hand Surgery,5 cases were excellent,3 cases were good,and 1 case was fair.The hand function recovered well and returned to work and daily life on average 6 weeks after operation.Conclusion The polyfoliate conjoined ALTP can repair the soft tissue defect of hand dorsum with multiple fingers at one stage,and the flap is in good shape.There is no need to divide th

关 键 词：股前外侧穿支皮瓣 多叶连体皮瓣 手背 手指 软组织缺损 修复 

分 类 号：R658.2[医药卫生—外科学]