摘要
目的 总结 93 1例手部损伤修复与重建的方法和经验。方法 断指 (肢 )患者均急诊作再植术。手部皮肤缺损面积较大者作吻合血管的皮瓣移植 ,缺损面积较小者均选用带血管蒂的岛状皮瓣移位。拇、手指缺损者 ,选择游离第二足趾、趾甲皮瓣、趾末节移植和趾背甲皮瓣移植瓦合带指神经血管蒂岛状皮瓣移位等方法再造拇手指。吻合断伤血管 79例 ,缝接断伤的上肢神经 10 9例 ,在手术显微镜下修复前臂及手部肌腱 416例。结果 断指 (肢 )再植 179例 2 49指 ,成活率达 97.18%。吻合血管的组织瓣移植 41例 ,成活率为 97.5 6%。带血管蒂的岛状皮瓣移位 10 7例 ( 111)块 ,成活率 95 .3 2 %。单根血管吻合后血流均通畅 (彩色超声多普勒仪测定 )。结论 手外伤后涉及的组织缺损或损伤较多 ,要获得良好的功能恢复 ,术前选择一个合适的修复或再造方案是非常重要的。
Objectives To summarize the methods and experiences of repair and reconstruction after hand injuries. Methods Emergency replantation was indicated for patients with severed fingers or limbs. Vascularized flap transplantation or pedicled island flap transfer was indicated for major or minor skin defect in the hand respectively. Treatment options for reconstruction of thumb and finger defect include: free second toe transfer, wrap around flap, transplantation of the distal segment of the big toe, and combined transfer of digital neurovascular island flap and wrap around flap. Vascular anastomosis was done in 79 cases. Nerve repair was done in 109 cases. Microscopic suture of the tendons in the hand and forearm was performed in 416 cases. Results The survival rate of replanted fingers and limbs was 97.18%. Vascularized flap transplantation was done in 41 cases, with a survival rate of 97.56 %. The survival rate of 107 cases of 111 pedicled island flaps was 95.32 %. Fluent blood flow was observed in the anastomosed vessels by colour Doppler ultrasonography. Conclusions Preoperative planning of a proper repair or reconstruction procedure is of great importance if excellent functional recovery is required in case of hand injury with major tissue defects.
出处
《中华手外科杂志》
CSCD
2000年第3期164-166,共3页
Chinese Journal of Hand Surgery
基金
上海市医学领先学科基金!资助项目 (98 0 0 2 )
关键词
外科皮瓣
手损伤
显微外科手术
治疗
Free flaps
Hand injuries
Microsurgery
Treatment outcome
