利用游离皮瓣超级Flow-through技术成功完成手掌部毁损的单手多指离断再植1例  

Free flap combined with super Flow-through technique in replantation of multiple amputated digits in one hand with destructive palm injury:a case report

作　　者：王腾 宗海洋 范新宇 何晓清 蔡兴博 吕黎明 徐永清 WANG Teng;ZONG Haiyang;FAN Xinyu;HE Xiaoqing;CAI Xingbo;LYU Liming;XU Yongqing(Department of Orthopaedics,920 Hospital,Joint Logistics Support Force,Kunming 650032,China)

机构地区：[1]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650032

出　　处：《中华显微外科杂志》2024年第6期690-694,共5页Chinese Journal of Microsurgery

基　　金：云南省骨科与运动康复临床医学研究中心(202102AA310068);云南省创伤骨科临床医学中心(ZX20191001)。

摘　　要：2017年2月,中国人民解放军联勤保障部队第九二〇医院骨科收治1例因水泥搅拌机致右手掌部毁损、5指完全离断的19岁男性患者,急诊术中彻底清创后,利用游离股前外侧穿支皮瓣(ALTPF)超级Flow-through技术结合经典断指再植技术,成功完成第1~4指再植,小指未再植,皮瓣供区直接缝合。二期行双侧跖肌腱移植及右侧腓肠神经移植,对再植指行运动及感觉功能重建。术后2年随访,右手第1~4指及皮瓣质地柔软,无破溃,感觉恢复至S2+级,恢复了一定的屈、伸功能,可满足日常基本生活需要。参照中华医学会手外科学会上肢部分功能评定试用标准,功能恢复可。皮瓣供区仅遗留线形瘢痕。A 19-year old male patient with multiple traumatic amputations of all digits and destructive injury in one hand caused by a cement mixer was admitted in the Department of Orthopaedics,920 Hospital,Joint Logistics Support Force,in February 2017.In the emergency surgery,the severed thumb and a bundle of severed index,middle and ring fingers were successfully replanted using super Flow-through technique with transfer of a free anterolateral thigh perforator flap(ALTPF).The little finger was abandoned.The donor site of the flaps were sutured directly.In stage II surgery,bilateral metatarsal tendon transfer and right sural nerve transfer were performed to rebuild the motor and sensory functions of the replanted digits.At 2 years of postoperative follow-up,the texture of the replanted 1st-4th digits and transferred flap in right hand was soft without rupture,and the sensation was restored to S 2+.Some digital flexion and extension were restored,which enable the patient to fulfil the most essential requirement in daily life.According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association,the functional recovery was fear.Only a linear scar remained at the donor site of thigh.

关 键 词：断指再植 游离皮瓣 超级Flow-through技术 手掌毁损伤 

分 类 号：R658.1[医药卫生—外科学]