游离股薄肌肌瓣联合腓肠神经移植重建腕部电烧伤患者手屈指和感觉功能的效果  

Effects of free gracilis muscle flap combined with sural nerve transfer for reconstruction of digital flexion and sensory function of hand in patient with wrist electric burn

作　　者：夏成德[1] 狄海萍[1] 邢培朋 黄万新 薛继东[1] 曹大勇[1] 郭海娜 刘磊[1] 栗鹏程[3] Xia Chengde;Di Haiping;Xing Peipeng;Huang Wanxin;Xue Jidong;Cao Dayong;Guo Haina;Liu Lei;Li Pengcheng(Department of Burns,the First People's Hospital of Zhengzhou,Zhengzhou 450004,China;Department of Osteology,the First People's Hospital of Zhengzhou,Zhengzhou 450004,China;Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]郑州市第一人民医院烧伤科,郑州450004 [2]郑州市第一人民医院骨科,郑州450004 [3]北京积水潭医院手外科,北京100035

出　　处：《中华烧伤与创面修复杂志》2023年第3期228-233,共6页Chinese Journal of Burns And Wounds

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202002126)。

摘　　要：目的探讨游离股薄肌肌瓣联合腓肠神经移植重建腕部严重电烧伤患者手屈指和感觉功能的效果。方法采用回顾性观察性研究方法。2017年1月—2020年12月,郑州市第一人民医院烧伤科与北京积水潭医院手外科分别收治4例符合入选标准的腕部高压电烧伤患者,其中男6例、女2例,年龄12~52岁,腕部高压电烧伤分型均为Ⅱ型,正中神经均缺损。Ⅰ期应用游离股前外侧肌皮瓣修复创面,于创面愈合3~6个月后Ⅱ期应用游离股薄肌肌瓣联合腓肠神经移植重建患手屈指和感觉功能。肌瓣、神经切取长度分别为32~38、28~36 cm。将肌瓣供区和神经供区均拉拢缝合。术后观察和记录股薄肌肌瓣和腓肠神经成活情况、前臂受区创面愈合时间、肌瓣供区和神经供区缝合口愈合时间,随访供受区恢复情况。术后2年,根据中华医学会手外科学会上肢部分功能评定试用标准中手部肌腱、神经修复评定标准,评价手功能重建后屈拇屈指的肌力和手指感觉功能。结果术后股薄肌肌瓣和腓肠神经全部成活。前臂受区创面愈合时间为术后10~14 d,肌瓣供区及神经供区缝合口愈合时间为术后12~15 d,供受区恢复良好。术后2年随访,屈拇屈指肌力评定:5级者4例、4级者3例、2级者1例;手指感觉功能评定:S3+级者4例、S3级者2例、S2级者2例。结论对腕部严重电烧伤致手功能障碍患者,应用游离股薄肌肌瓣联合腓肠神经移植重建患手屈指和感觉功能,是一种较佳修复方法,且不会对大腿肌瓣供区和小腿神经供区造成较大损伤。Objective To explore the effects of free gracilis muscle flap combined with sural nerve transfer for reconstruction of digital flexion and sensory function of hand in patient with severe wrist electric burn.Methods A retrospective observational study was conducted.From January 2017 to December 2020,4 patients with wrist high-voltage electric burn admitted to the Department of Burns of the First People's Hospital of Zhengzhou and 4 patients with wrist high-voltage electric burn admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital met the inclusion criteria,including 6 males and 2 females,aged 12 to 52 years.They were all classified as typeⅡwrist high-voltage electric burns with median nerve defect.In the first stage,the wounds were repaired with free anterolateral thigh femoral myocutaneous flap.In the second stage,the free gracilis muscle flap combined with sural nerve transplantation was used to reconstruct the digital flexion and sensory function of the affected hand in 3 to 6 months after wound healing.The cut lengths of muscle flap and nerve were 32 to 38 and 28 to 36 cm,respectively.The muscle flap donor area and nerve donor area were both closed and sutured.The survival condition of gracilis muscle flap and sural nerve,the wound healing time of recipient area on forearm,the healing time of suture in muscle flap donor area and nerve donor area were observed and recorded after operation,and the recovery of donor and recipient areas was followed up.In 2 years after operation,the muscle strength of thumb and digital flexion and finger sensory function after the hand function reconstruction were evaluated with the evaluation criteria of the hand tendon and nerve repair in the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association.Results All the gracilis muscle flap and sural nerve survived successfully after operation.The wound healing time of recipient area on forearm was 10 to 14 days after operation,and the healing time of su

关 键 词：烧伤 电 手损伤 股薄肌 外科皮瓣 显微外科手术 腕 功能重建 

分 类 号：R644[医药卫生—外科学] R616.2[医药卫生—临床医学] R622+.1