带神经的组织瓣分期修复全手脱套伤5例  

Reconstruction of whole hand degloving injury by transfer of nerved tissue flaps in staged surgery:5 cases report

作　　者：王克列 邹时雨 肖春生 陈品琨 张宜之 马立峰 杨延军 张子清 Wang Kelie;Zou Shiyu;Xiao Chunsheng;Chen Pinkun;Zhang Yizhi;Ma Lifeng;Yang Yanjun;Zhang Ziqing(Department of Hand Surgery,Longgang Orthopaedics Hospital of Shenzhen,Shenzhen 518116,China)

机构地区：[1]深圳市龙岗区骨科医院手外科,深圳518116

出　　处：《中华显微外科杂志》2025年第1期31-38,共8页Chinese Journal of Microsurgery

基　　金：广东省医学科研基金(B2023410);深圳市龙岗区医疗卫生科技计划(LGWJ2023-153);龙岗区医学重点学科建设项目(440307240221533600176)。

摘　　要：目的探讨采用带神经的组织瓣分期修复全手脱套伤的临床效果及可行性。方法回顾性分析2018年12月至2022年12月于深圳市龙岗区骨科医院手外科就诊,采用带神经组织瓣分期修复全手脱套伤5例患者的临床资料,其中男4例,女1例,年龄22~45岁,左手2例,右手3例。2例合并甲粗隆骨折,1例合并伸肌腱止点部分断裂。脱套面积215~480 cm^(2),修复拇指的甲瓣面积54~104 cm^(2),修复示指的甲瓣面积65~133 cm^(2),修复手部残余创面的皮瓣面积119~255 cm^(2)。一期采用双侧甲瓣再造拇、示指及覆盖虎口区皮肤,重建拇、示指外观及感觉功能;同时将中、环、小指并指合拢,与残余的手掌、手背创面合并成一个整体创面,再以一侧的ALTF修复;双侧甲瓣供区以另一侧的分叶ALTF或者双侧腓动脉穿支皮瓣修复,ALTF、腓动脉穿支皮瓣供区直接缝合;待手部甲瓣及ALTF成活稳定后分次行环、小指及中、环指分指术。二期再以足趾侧方皮瓣替换中、环指指腹桡侧及小指指腹尺侧区域的皮肤,重建中、环、小指指腹主要感觉区域的感觉功能。最后对手指外形、TPD和伸、屈功能进行门诊随访,采用中华医学会手外科学会拇、手指再造功能评定标准进行评估。对足部供区的外观及功能采用Maryland足功能评定标准进行评估。结果术后所有皮瓣均成活。末次手术后随访14~48个月,手指外形满意,功能良好,拇、示指指腹TPD 6~8 mm,中、环、小指指腹主要感觉区的TPD 3~8 mm,指腹非主要感觉区TPD 10~14 mm,根据中华医学会手外科学分会拇、手指再造功能评定标准评分13~14分,均评为优;大腿供区仅留线状瘢痕,足部皮瓣不臃肿,行走、奔跑无明显异常,根据Maryland足功能评定标准评分96~97分,均评为优。结论应用带神经的组织瓣分期修复全手脱套伤,修复后的手部外形较为满意,功能良好,供区外形、功能影响较小,是一种新颖的全�Objective To explore the feasibility and effect on the reconstruction of whole hand degloving injury by transfer of nerved tissue flaps in staged surgery.MethodsA retrospective study was conducted on the clinical data of 5 patients who suffered whole hand degloving injury and underwent staged reconstructive surgery with nerved tissue flaps,from December 2018 to December 2022 in the Department of Hand Surgery,Longgang Orthopaedics Hospital of Shenzhen.The patients were 4 males and 1 female,aged 22-45 years.Two of the whole-hand degloved injuries were left hands and 3 of right.Two patients had the whole-hand degloving injury combined with a fracture of distal phalangeal tuberosity,and 1 was complicated with partial rupture of the extensor tendon insertion.Areas of the whole hand degloving injury ranged from 215 cm^(2) to 480 cm^(2),the size of the hallux nail flaps for reconstruction of thumbs ranged from 54 cm^(2) to 104 cm^(2),the size of the hallux nail flaps for reconstruction of index fingers ranged from 65 cm^(2) to 133 cm^(2),and the size of the flaps for reconstruction of all the defects of hands ranged from 119 cm^(2) to 255 cm^(2).In primary surgery,the thumbs,index fingers and the first webs were reconstructed with bilateral hallux nail flaps to shape the appearance and gain the sensation function.Meanwhile,a single and large defect was created from the defects of hand by bundling up the middle,ring and little fingers together with the all the defects in both palmar and dorsal hand.Then an anterolateral thigh flap(ALTF)was used to have the created single defect wrapped together.Donor sites of the bilateral hallux nail flap were reconstructed with a lobulated ALTF from the other side or with bilateral peroneal artery perforator flaps.Donor sites of the ALTF and peroneal artery perforator flap were pulled and sutured.After the hallux nail flaps and ALTFs of the affected hands had survived and stabilised,multiple staged surgery were then carried out to firstly reconstruct the ring and little fingers,and fol

关 键 词：全手脱套伤 组织瓣 甲瓣 股前外侧皮瓣 移植 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]