摘要
目的探讨蹰趾腓侧皮瓣与第二趾甲皮瓣瓦合修复拇、手指套脱伤的临床应用。方法采用多种不同手术方法修复手指套脱伤,其中采用(?)甲瓣加第二趾胫侧皮瓣修复拇指套脱伤9例。采用躅趾腓侧皮瓣加第二趾甲皮瓣修复多指套脱伤15例20指。采用双侧躅腓侧皮瓣加双侧第二趾甲皮瓣带足背皮瓣加足外侧皮瓣修复示、中、环指套脱伤1例。采用双侧第二趾甲皮瓣加双(?)腓侧皮瓣加双足背皮瓣和股前外侧皮瓣修复手部套脱伤1例。结果26例34指59块皮瓣,其中有1块皮瓣坏死,经重新植皮后愈合；其余58块皮瓣全部成活。术后18例23指获得随访,随访时间为6～9个月。除手指末节指间关节活动受限外,其余指间关节活动均接近正常,指甲生长尚好,外形接近正常,手指两点分辨觉为5～8mm。供区功能无影响。结论(?)趾腓侧皮瓣(或躅甲瓣)与第二趾甲皮瓣(或第二趾胫侧皮瓣)瓦合修复拇手指套脱伤,术后手指功能好,外观满意,是治疗拇、手指套脱伤较好的术式。
Objective To evaluate the treatment outcome of using vascularized fibular pulp flap of the big toe combined with wrap-around flap of the second toe for repair of degloving injuries of the thumb and fingers. Methods 34 degloved fingers in 26 cases were treated, of which 9 cases involved the thumb and 15 cases involved 20 fingers. The thumb defect was repaired by wrap-around flap of the big toes combined with the pulp flap of the second toe. The finger defects were repaired by pulp flap of the big toes combined with wrap-around flap of the second toes. 3 fingers in 1 case were covered with fibular pulp flap of the big toe and wrap-around flap of the second toe combined with dorsalis pedis flap and lateral dorsalis pedis flap. The area of the flaps were 6 cm × 3.5cm to 6 cm × 2.5 cm and 5 cm × 3.5 cm to 5 cm × 2.5 cm. 1 case of total hand degloving injury was repaired with bilateral wrap-around flaps from second toes combined with bilateral pulp flaps from big toes and bilateral dorsal flaps and anterolateral thigh flap. Results One flap of 59 flaps of 34 fingers in 26 cases had necrosis that was taken care of by secondary skin graft. The rest flaps all survived. 23 fingers in 18 cases were followed-up more than 6 months. Movement of the joints were near normal except that of the distal interphalangeal joint. The nail grew well and had a good appearance. 2-PD was 5 - 8 mm. Function of the donor foot was not impaired. Conclusion Vascularized fibular pulp flap of the big toe combined with wrap-around flap of the second toe was one of the best options to repair degloving injury of the thumb and fingers.
出处
《中华手外科杂志》
CSCD
北大核心
2006年第2期75-77,共3页
Chinese Journal of Hand Surgery
关键词
指损伤
组织移植
显微外科手术
治疗结果
Finger injuries
Tissue transplantation
Microsurgery
Treatment outcome
