腹部S形切口带蒂瓦合皮瓣修复手掌及手背大面积软组织缺损  

Repair of large soft tissue defects on the palm and back of the hand with the pedicled over and out abdominal flap designed by"S"shaped incision

作　　者：赵伟超 范红旗[1] 陶忠生[1] 魏斌[1] 陈京亮 郭永军 冯亚高 ZHAO Weichao;FANG Hongqi;TAO Zhongsheng(Department of Orthopedic Third Ward,The 82nd Group Military Hospital of PLA,Baoding,Hebei,071000,China)

机构地区：[1]中国人民解放军陆军第82集团军医院骨三科,河北保定071000 [2]古冶巴克医院创面修复科,河北唐山063000

出　　处：《实用手外科杂志》2024年第4期432-434,共3页Journal of Practical Hand Surgery

摘　　要：目的探讨腹部S形切口带蒂瓦合皮瓣修复手掌及手背大面积软组织缺损的方法及临床疗效。方法对2020年1月-2023年5月收治的8例手掌与手背大面积软组织缺损伴骨、肌腱外露患者,在患肢同侧腹部设计一S形切口,切开后形成两个“舌”形瓣,分别覆盖修复掌侧及背侧创面,供区不植皮直接缝合。结果患者术后均获得12~72个月随访。8例交腹带蒂瓦合皮瓣均成活良好。其中1例皮瓣术后感染,经伤口换药2周后感染控制,无皮瓣坏死,但该病例因外伤导致的尺神经断裂缺损及指屈肌腱损伤,使术后功能恢复较差;其余7例皮瓣愈合良好,功能恢复良好。结论腹部S形切口带蒂瓦合皮瓣作为一种随意皮瓣,修复手掌及手背大面积软组织缺损,供区切取面积大,无固定营养血管限制,供区隐蔽,是一种实用、有效、容易开展的手术方式。Objective To explore the method and clinical effect of repairing large soft tissue defects on the palm and back of the hand with the pedicled over and out bdominal flap designed by a"S"shaped incision.Methods A retrospective analysis was conducted on 8 patients with extensive soft tissue defects of the palm and back of the hand,bone and tendon exposure,who were admitted from January 2020 to May 2023.Designed an S-shaped incision on the same side of the affected limb's abdomen to form two tongue shaped flaps,covered and repaired the wounds on the palmar and dorsal sides respectively.The donor area was directly sutured without skin grafting.Results All patients were followed up for a period of 12-72 months.All the flaps of 8 patients with over and out abdominal flaps survived well,including 1 case of postoperative infection of the flap.After 2 weeks of wound dressing change,the infection was controlled,and no flap necrosis was found.This case also suffered from ulnar nerve rupture,defect,and flexor tendon injury caused by trauma,resulted in poor postoperative functional recovery.The remaining 7 patients had good skin flap healing and functional recovery.Conclusion The pedicled over and out abdominal flap designed by a"S"shaped incision,as a type of random flap,is used to repair large soft tissue defects on the palm and back of the hand.The abdominal donor area has a large resection area,is not limited by fixed nutrient vessels,and the donor area is concealed.It is a practical,effective,and easy to carry out surgical method.

关 键 词：手 外科皮瓣 撕脱伤 瓦合修复 

分 类 号：R658.2[医药卫生—外科学]