摘要
目的报道伴有手部皮肤缺损的急诊拇指和手指再造的手术方法及临床疗效。方法急诊对11例伴有手部皮肤缺损的拇、手指缺损伤患者，采用双足带足背皮瓣的趾甲皮瓣或足第二趾组合移植进行修复，其中应用带足背皮瓣的躅甲瓣组合带足背皮瓣的第二趾甲皮瓣5例；应用带足背皮瓣的躅甲瓣组合带足背皮瓣的第二趾3例；应用双足带足背皮瓣的第二趾组合修复3例。其中1例再造3个手指，10例再造2个手指。5例采用同蒂多叶皮瓣的趾甲皮瓣或第二趾移植修复，6例采用带足背皮瓣的趾甲皮瓣或第二趾移植修复。结果除1例再造3个手指者1指坏死外，其余组织瓣及再造手指均成活。术后伤口均一期愈合。随访5～24个月，修复后的手指基本恢复了抓、捏、握的功能，手部外形得到了一定的恢复，再造指及皮瓣的感觉恢复S2～S4。足部供区愈合较满意，无明显的瘢痕挛缩，不影响足部行走功能。结论急诊采用双足带足背皮瓣的趾甲皮瓣，或第二趾组合移植修复伴有手部皮肤缺损的拇、手指缺损伤．可以恢复伤手一定的功能外形，是一种有效的治疗方法。
Objective To determine the surgical approaches and evaluate the clinical efficacy of skin defects of the emergency thumb, finger reconstruction. Methods Emergency in 11 cases complicated skin defect of the thumb and the hand, fingers missing injured patients by using the method of combined of toenail flap of biped dorsalis pedis flap or the second toe. The implantation of thumbnail flap of dorsalis pedis flap combined with the second toenail flap was applied on 5 cases. 3 cases had received the implantation of thumbnail flap of dorsalis pedis flap combined with the second toe and 3 cases with combined repair of the second toe of biped dorsal flap. Of all the cases, reconstruction of 3 fingers in 1 case,＇ reconstruction of 2 fingers in 10 cases, 5 cases with reconstruction by means of implantation of toenail flap of same pedicle splitting flap or the second toe, 6 cases with repair of toenail flap of dorsalis pedis flap or second toe. Results Except for 1 necrosis occurred in 1 finger in 1 case of 3 fingers reconstruction, the rest of tissue flaps and fingers all survived. The primary healing was achieved postoperatively. The patients were followed up for 5-24 months. The functions such as grabbing, grasping, nipping were basically restored after the repair. The appearance of hand was also restored to a certain degree. Sensory recovery S2-S4 of reconstruction finger and flap was achieved. Healing was satisfying in the donor area, no obvious cicatricial eontracture was seen, while the walk function was not affected. Conclusion The application of combined implantation of toenail flap of biped dorsalis pedis flap or the second toe in the repair of overall hand skin degloving injury could restore the function and appearance of the injured hands to a certain degree. It is proved to be an effective treatment method.
出处
《中华显微外科杂志》
CSCD
北大核心
2010年第3期200-202,I0005,共4页
Chinese Journal of Microsurgery
基金
江苏省自然科学基金资助项目（BK2008178）
关键词
手
拇指
指
皮肤套状撕脱伤
移植
再造
显微外科手术
Hand
Thumb
Finger
Hand skin degloving injury
Implantation
Reconstruction
Microsurgical operation
