携带神经的腓动脉穿支皮瓣修复腕部电烧伤后期神经缺损的临床效果  

Clinical effects of nerve-carrying peroneal artery perforator flaps in repairing nerve defects in the late stage of wrist electric burns

作　　者：周健 郑玉岑 陈伟 常树森 魏在荣 聂开瑜 张芳 Zhou Jian;Zheng Yucen;Chen Wei;Chang Shusen;Wei Zairong;Nie Kaiyu;Zhang Fang(Department of Burns and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563003,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,遵义563003

出　　处：《中华烧伤与创面修复杂志》2024年第9期835-841,共7页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金地区科学基金项目(82360445)。

摘　　要：目的探讨携带神经的腓动脉穿支皮瓣修复腕部电烧伤后期神经缺损的临床效果。方法该研究为回顾性观察性研究。2019年12月—2023年5月,遵义医科大学附属医院收治5例符合入选标准的腕部电烧伤后期神经缺损致手部感觉功能障碍患者,其中男4例、女1例,年龄7~48岁。正中神经、尺神经均缺损者4例,仅正中神经缺损者1例,神经缺损长度为5~12 cm。对4例患者行携带腓肠神经和腓浅神经的腓动脉穿支皮瓣移植,1例患者行仅携带腓肠神经的腓动脉穿支皮瓣移植。将皮瓣供区创面直接拉拢缝合。1例患者合并肌腱粘连,同期行肌腱粘连松解;3例患者合并腕屈肌肌群缺损,其中同期行自体肌腱移植者2例、Ⅱ期行股薄肌肌皮瓣屈指功能重建者1例;1例患者合并腕关节屈曲挛缩,Ⅱ期行挛缩松解。术后随访观察皮瓣成活情况,记录皮瓣供受区切口/缝合口愈合时间及手部感觉恢复时间。末次随访时,观察皮瓣供区瘢痕形成情况及足部感觉缺失情况;根据中华医学会手外科学分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,分别评价屈指肌力和手指感觉功能。结果患者术后获随访12~24个月,所有患者皮瓣均成活,皮瓣供受区切口/缝合口愈合时间均约为2周,手部感觉在术后6个月内恢复。末次随访时,小腿供区遗留线性瘢痕,足背遗留部分皮肤感觉障碍,无皮肤破溃,不影响穿鞋及行走;屈指肌力评定为4级者1例、3级者3例、2级者1例;手部感觉功能评定为S3+级者4例,皮肤两点辨别觉距离为8~11 mm;手部感觉功能评定为S3级者1例,皮肤两点辨别觉距离为13 mm。结论采用携带神经的腓动脉穿支皮瓣修复腕部电烧伤后期神经缺损,手部感觉在6个月内恢复,皮瓣供区仅遗留线性瘢痕,足背仅有部分区域感觉减退;结合屈指功能重建,能有效改善手部整体功能。Objective To explore the clinical effects of nerve-carrying peroneal artery perforator flaps in repairing nerve defects in the late stage of wrist electric burns.Methods This study was a retrospective observational study.From December 2019 to May 2023,five patients with sensory dysfunction in hands due to nerve defects in the late stage of wrist electric burns were treated in the Affiliated Hospital of Zunyi Medical University and met the inclusion criteria.There were 4 males and 1 female,aged 7 to 48 years.Four patients had defects in both median nerve and ulnar nerve,one patient had a defect solely in median nerve,and the length of nerve defects ranged from 5 to 12 cm.Four patients underwent transplantation of peroneal artery perforator flaps carrying sural nerve and superficial peroneal nerve,and 1 patient underwent transplantation of peroneal artery perforator flap only carrying sural nerve.The wounds in flap donor sites were all directly sutured.One patient had tendon adhesion and release of tendon adhesion was performed during the same surgery;3 patients had combined defects in the wrist flexor muscle group,including 2 patients received autologous tendon grafting during the same surgery,and one patient received reconstruction of finger flexion function with a gracilis myocutaneous flap in the second stage;1 patient had combined wrist flexion contracture which was surgically released in the second stage.During follow-up after surgery,the survival of the flaps was observed,and the healing time of the incisions or sutures in flap donor and recipient sites and the recovery time of hand sensation were recorded.At the last follow-up,the scar formation and loss of sensation in the foot were observed,and flexor strength and sensory function of the fingers were evaluated based on the evaluation criteria for tendon and nerve repair standards of hands in the trial standards for evaluation of partial function of the upper extremity by the Hand Surgery Society of Chinese Medical Association.Results All patients were fol

关 键 词：烧伤 电 腕 穿支皮瓣 腓肠神经 腓浅神经 神经缺损 功能重建 

分 类 号：R647[医药卫生—外科学]