带感觉功能上臂外侧嵌合骨皮瓣游离移植修复手指复合组织缺损的效果观察  

Application of free upper-limb lateral chimeric bone-skin flap with sensation in repair of finger composite tissue defect

作　　者：张松 黎章灿 潘勇 吴尧 陈步国 Zhang Song;Li Zhangcan;Pan Yong;Wu Yao;Chen Buguo(Department of Hand Surgery,Xuzhou Renci Hospital,Xuzhou 221004,China)

机构地区：[1]徐州仁慈医院手外科,徐州221004

出　　处：《中华解剖与临床杂志》2022年第4期256-261,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨带感觉功能上臂外侧嵌合骨皮瓣修复手指复合组织缺损的临床效果。方法回顾性研究。纳入2016年11月—2019年11月徐州仁慈医院手外科收治的6例手指软组织缺损伴指骨、神经缺损患者。其中,男4例,女2例;年龄33~61岁,平均47.3岁;右手2例,左手4例;拇、示、中指各1例,环指3例;皮肤缺损面积1.0 cm×1.5 cm~2.5 cm×3.0 cm,骨缺损长度1.5~2.5 cm。6例患者均采用一期创面彻底清创,创面缺损伴指骨、神经缺损先行异种皮覆盖创面,克氏针维持骨折稳定性;二期带感觉功能的上臂外侧嵌合骨皮瓣游离移植修复治疗,皮瓣设计面积1.5 cm×2.0 cm~3.0 cm×3.5 cm,骨瓣切取大小为1.5 cm×1.0 cm×1.0 cm~3.0 cm×1.5 cm×1.0 cm。术后采用中华医学会手外科学会手部功能评定标准评价手功能,英国医学研究委员会(BMRC)制定的感觉分级方法评价皮瓣感觉恢复效果,Michigan手部功能问卷评定标准评定患指外观满意度。结果本组6例患者手术均顺利完成,术后随访3~7个月,平均13.5个月。6例皮瓣全部成活,骨折均愈合,骨瓣平均愈合时间3~6个月,平均3.5个月。供区直接缝合,创面均一期愈合。手部功能优5例、良1例,手指感觉恢复至S4级4例、S3+级2例,患指外观满意度评价非常满意1例、满意4例、一般1例。结论带感觉功能的上臂外侧嵌合骨皮瓣游离移植,可同时修复手指软组织缺损和指骨缺损,对供区影响小,术后手指感觉功能恢复好,是修复手指复合组织缺损的备选方案之一。Objective To investigate the clinical effect of application of free upper-limb lateral chimeric bone-skin flap with sensation in the repair of finger composite tissue defect.Methods A retrospective study was performed on six patients(4 males and 2 females,aged 33–61 years,mean age 47.3 years)with finger soft-tissue defects associated with phalanx nerve defects.The patients were admitted to the Hand Surgery Department of Xuzhou Renci Hospital from November 2016 to November 2019.These patients exhibited 2 cases of right-hand and 4 cases of left-hand defects,1 case of thumb defect,and 1 case of index finger defect.Furthermore,1 case of middle-finger and 3 cases of ring-finger defects were observed.The skin defect area of the finger was 1.0 cm×1.5 cm–2.5 cm×3.0 cm,and the bone defect length was 1.5–2.5 cm.All the patients were treated with first-stage thorough wound debridement.The wound defect with phalangeal nerve defect was covered by heterograft skin first.The upper-arm lateral chimeric bone flap with sensation was grafted and repaired with Kirschner wire to maintain fracture stability.The designed skin flap area was 1.5 cm×2.0 cm–3.0 cm×3.5 cm,and the size of the bone flap was 1.5 cm×1.0 cm×1.0 cm–3.0 cm×1.5 cm×1.0 cm.Postoperative function was evaluated according to the hand function evaluation standard of the Chinese Society of Hand Surgery of the Chinese Medical Association.Sensory recovery was evaluated by sensory grading method developed by the British Medical Research Council.The appearance satisfaction of the affected finger was evaluated based on the Michigan Hand Function Questionnaire.Results All the 6 patients were followed up for 3–72 months,with an average of 13.5 months.All the flaps survived,the fractures healed.The average healing time of bone flaps was 3.5(3–6)months.Primary healing of all wounds with direct suture at donor site was excellent in 5 cases and good in 1 case.Finger sensation was restored to S4 in 4 cases and S3+in 2 cases.Appearance satisfaction evaluation of

关 键 词：外科皮瓣 指损伤 软组织损伤 骨缺损 骨皮瓣 

分 类 号：R658.2[医药卫生—外科学]