摘要
目的报道应用足背分叶皮瓣一次修复多个手指电烧伤组织缺损的治疗效果。方法创面进行清创后,分别设计以胫前、足背血管为主干,跗内侧、第1跖背、跗外侧血管为分支,构成的足内侧、第1跖背、足外侧三叶皮瓣或以第1跖背、跗外侧血管为分支构成的第1跖背、足外侧双叶皮瓣移植一次修复2～3指皮肤软组织缺损,合并屈肌腱、血管、神经缺损的病例,以携带的趾长伸肌腱重建肌腱缺损,以足背动脉的分支血管桥接指动脉,以携带皮神经重建皮瓣感觉的同时重建手指远端的感觉。结果移植皮瓣全部成活,手指创口一期愈合,供足植皮部分坏死2例,1例经局部换药3周后愈合,1例肌腱外露行内踝上皮瓣移位修复后愈合。术后经3～24个月随访,皮瓣外形,质地良好,感觉恢复S_(3+)级,5例手指屈伸活动恢复正常,2例手指屈伸轻微受限。结论足背分叶皮瓣游离移植是修复多指电烧伤组织缺损最为理想的治疗方法。
Objective To report the therapeutic effect of free dorsum flap lobule grafting to repair soft tissue defects in two or three fingers result from electric burn in just one operation. Methods Seven patients with electric injuries in two or three fingers were treated by the dorsum flap （or composite flap） lobule grafting. The procedure is followed ： after debridement, a trifoliated flap composed of medial pedal, first dorsal metatarsal and lateral pedal flaps or a bifoliated flap composed of first dorsal metatarsal and lateral pedal flaps was designed. The combined flap contained anterior tibial artery and dorsal pedal artery as the stem vessel for anastomosing with the supplying vessel. The three tributaries of dorsal pedal artery ： medial tarsal artery, first dorsal metatarsal artery and lateral tarsal artery were contained in the three leaves respectively. They could contain extensor digitorum longus tendons and cutaneous nerves and be used to cover the skin defect of two or three fingers, reconstruct the flexor tendons and finger arteries and nerves at the same time. Results All the flaps were survived completely, the wounds in all fingers healed primarily, however, skin graft in two feet necrosised partly, one got to healing required wound dressing for three weeks, another required further operation of transferring medial supramalleolar flap due to tendon exposure. The patients were followed up from 3 to 24 months, all the flaps were of appropriate thickness, good texture and satisfactory sensation, all the fingers recovered good function of flection and extension except two fingers existing little limitation. Conclusion Free dorsum flap lobule grafting is an ideal way to treat electric injuries of multiple fingers because it can reconstruct the skin, tendons, blood vessels and nerves in two or three fingers in just one operation.
出处
《中华显微外科杂志》
CSCD
北大核心
2007年第5期334-337,404,共5页
Chinese Journal of Microsurgery
关键词
手指
电烧伤
足背皮瓣
移植
显微外科
Fingers
Electic injuries
Free dorsum flap
Transplantation
Microsurgery
