应用足部分叶皮瓣修复合并节段性损伤的手指离断伤  

Use a leaflet flap of foot to severed multi-finger with segmental injury

作　　者：杨林 史卫东 张建政[1] 赵建文 YANG Lin;SHI Wei-dong;ZHANG Jian-zheng;ZHAO Jian-wen(Microsurgery,Senior Department of Orthopaedics,the Fourth Medical Center of PLA General Hospital,Beijing100048,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部显微外科,北京100048

出　　处：《中国骨伤》2023年第8期708-713,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨应用足部分叶皮瓣修复合并节断性损伤的手指离断伤的再植手术方法。方法:自2018年1月2022年11月,采用第1跖背动脉为血管蒂的分叶皮瓣修复治疗8例合并软组织缺损的断指患者,其中男7例,女1例;年龄20~55岁;缺损面积(1.0~2.0)cm×(3.0~4.5)cm。观察术后患者手指活动度、日常生活功能、感觉功能、外形等指标。根据中华医学会手外科学会断指再植功能评定试用标准和Maryland足功能评分进行临床疗效评定。结果:8例手指及皮瓣全部成活,所有患者获得随访,时间4~20个月。手指皮色、皮温正常,耐磨性、耐寒性好。依据中华医学会手外科学会上肢部分功能评定试用标准评定手术效果,功能总评分61~92分,优4例,良4例。根据Maryland足功能评分,总分93~100分;优8例。结论:利用足部第1、2趾趾蹼带动、静脉的分叶皮瓣修复合并软组织缺损的断指,能够桥接血管,增加伤指软组织容量,避免手指短缩,患者满意度高。Objective To explore asurgical methods for replantation of severed finger.Methods From January 2018 to November 2022,8 amputated-finger patients were performed surgical reconstructions by using polyfoliate free flaps with the first dorsal metatarsal artery,including 7 males and 1 female,aged from 20 to 55 years old,and defect areas ranged from(1.0 to 2.0)cm×(3.0 to 4.5)cm.Finger pulp sensation,shape and other relevant parameters were assessed following the upper extremity functional evaluation standard,which was put forward by Hand Surgery Branch of Chinese Medical Association.And maryland foot functional score was used to evaluate foot function.Results Amputated fingers and flaps of all the 8 patients were survived.All patients were followed up for 4 to 20 months,their finger color and temperature tured to normal,with good wear-resistance and cold-resistance.According to Hand Surgery Branch of Chinese Medical Association,functional score ranged 61 to 92;4 patients got excellent result and 4 good.Maryland foot functional score ranged from 93 to 100;and 8 patients got excellent result.Conclusion It is feasible to repair severed fingers with soft tissue defects using polyfoliate free flaps that driven by the flippers of the first and second toes of the foot.This method ccould bridge blood vessels,increase soft tissue volume of the injured finger,and avoid finger shortening,with high patient satisfaction.

关 键 词：第1跖背动脉 手指节段性损伤 断指再植 游离皮瓣 

分 类 号：R62[医药卫生—整形外科]