手部复合组织缺损的显微外科修复  

Repair of compound defect in the hand by compound or combined flap transfer

作　　者：侯书健[1] 程国良[1] 方光荣[1] 刘亚平[1] 张元信[1] 屈志刚[1] 王振军[1] 张云飞[1] 

机构地区：[1]中国人民解放军第四○一医院手外科,青岛市266071

出　　处：《中华显微外科杂志》2003年第1期9-11,共3页Chinese Journal of Microsurgery

摘　　要：目的　介绍吻合血管的复合组织移植或组合组织移植修复手部复合组织缺损的疗效。　方法　 1983年 12月～ 2 0 0 1年 6月 ,对 35例五类手部复合组织缺损进行手术治疗。采用带趾长伸肌腱的足背复合组织瓣移植修复手背皮肤缺损合并指伸肌腱缺损 4例 ;趾腓侧半复合组织瓣或第二足趾胫侧半复合组织瓣移植修复拇、手指末节半侧缺损 4例 ;带近侧趾间关节的节段性第二趾复合组织瓣移植修复拇、手指中段部分或完全缺损 8例 ;第二足趾与游离皮瓣组合移植为拇指缺损合并手部皮肤缺损者一期再造拇指并修复手部皮肤缺损 17例 ;双侧第二足趾桥接组合移植再造与修复近节指骨基底水平的长手指缺损 2例。　结果　临床上修复组织缺损 35例 ,成功 33例。术后经半年至 5年的随访 ,按中华医学会手外科学会上肢部分功能评定试用标准 ,优良率为 82 9%。　结论　吻合血管的复合组织移植或组合组织移植是修复手部复合组织缺损的比较理想方法。Objective To introduce the outcome of compound defect in the hand treated by compound flap transfer or combined flaps transfer. Method From Dec.1983 to June 2001,thirty-five cases with five kinds of compound defect in the hand were treated surgically.Among them,four cases with defect of skin and extensor tendon in the dorsum of hand were repaired by dorsalis pedis flap with tendons;Three cases with longitudinal subtotal loss of distal thumb and one case with longitudinal subtotal loss of distal middle finger were reconstructed with fibular segmental osteo-onychocutaneous flap from great toe or tibial segmental osteo-onychocutaneous flap from second toe;Eight cases with total or subtotal defect at middle part of thumb or fingers were reconstructed with segmental second toe; seventeen cases with defect of thumb and hand skin were reconstructed with combined transplantation of second toe and free skin flap;Two cases with middle finger defect at the base of proximal phalanx were reconstructed with bridging transplantation of bilateral second toe. Result Thirty-three cases were successful.Follow-up period ranged from 0.5 to 5 years postoperatively.The excellent and good rate was 82.9% assessed with provisional functional assessment criterion for upper limbs issued by Chinese Society of Hand Surgery. Conclusion The compound flap transfer or combined flaps transfer was an ideal method in repair of compound defect in the hand.

关 键 词：手部复合组织缺损 显微外科 吻合血管 手外科 

分 类 号：R658.2[医药卫生—外科学]