摘要
目的介绍急诊组织瓣移植或移位一期修复伴有严重血管损伤的上肢复杂性组织缺损的手术疗效。方法对10例伴有严重血管损伤的上肢复杂性组织缺损的患者，在修复血管重建肢体血运的同时，根据组织缺损需要采用皮瓣、肌皮瓣、骨皮瓣甚至组织瓣组合移植的方法急诊进行一期修复。其中上臂肱动、静脉长段缺损，合并肱二头肌及上臂内侧大面积皮肤缺损，血管修复后背阔肌皮瓣移位覆盖创面并重建屈肘功能3例；肘部血管损伤合并肘关节周围大面积皮肤撕脱缺损，血管修复后移植胸脐皮瓣覆盖创面2例；前臂尺、桡动脉损伤合并皮肤肌肉缺损，血管修复后移植股前外侧皮瓣覆盖创面3例；前臂尺桡动脉损伤并尺桡骨缺损，血管修复后移植腓骨皮瓣重建尺骨缺损，二期再移植腓骨皮瓣重建桡骨缺损1例；前臂尺、桡动脉损伤合并桡骨及大面积皮肤缺损，血管修复后股前外侧皮瓣加髂骨皮瓣组合移植1例。结果术后10例患肢及移位组织瓣全部存活。术后随访3—6个月，3例上臂损伤患者，肘关节最大屈曲度为105。，屈肘肌力为鸭～M4，手功能恢复基本正常；肘及前臂损伤的7例患者，肢体及移植皮瓣完全存活，骨皮瓣和腕部已达骨性愈合，并恢复部分手功能。结论对严重血管损伤且合并有复杂组织缺损的上肢损伤，急诊在施行血管修复重建肢体血运的同时，采用组织瓣单独或组合移植一期有效覆盖创面，可提高复杂性患肢的成活率，并为二期功能重建术提供良好的软组织条件。
Objective To report the surgical techniques and clinical outcomes of emergency tissue flap transfer （transpesition） for one-stage reconstruction of complex upper extremity tissue defects accompanied with severe vascular damage. Methods Ten cases of complex upper extremity tissue defects accompanied with vascular injuries were involved. The vessels were repaired to restore blood circulation of the limbs. Meanwhile based on the type and extent of tissue defects, cutaneous flaps, myocutancons flaps, estcocutancous flaps or composite flaps were transferred for one-stage repair. In 3 cases there were lengthy defect of the humeral artery and vein, biceps muscle defect and large skin defect on the medial side of the arm. The latissimus dorsi myocutaneous flap was transferred for wound coverage and elbow flexion reconstruction immediately after vascular repair. In 2 cases the vascular injuries were accompanied by the large soft tissue defect around the elbow. The thoraco-umbilical flap was transferred for wound coverage following vascular repair. Antemlateral thigh flap transfer combined with vascular reconstruction was carried out in 3 cases with skin and muscle defects accompanied with ulnar and radial artery injuries. In 1 ease there were ulnar artery damage and defect of forearm both bones. A fibular osteneutaneous flap was transferred to repair the ulna bone defect along with vascular reconstruction in the first stage. At the second stage, another fibular osteocutaneous flap was transferred to repair the radial defect. In 1 ease with combined forearm radial and ulnar artery damages, radial bone defect and large skin defect, combined transfer of the anterolateral thigh flap and iliac osteocutaneons flap were carried out in addition to the vascular repair. Results Postoperatively all the limbs and transferred tissues in the I0 cases sturvived. The patients were follow-up for 3 to 6 months. The 3 patients with defects at the ann level recovered ma^mum flexion of the elbow joint to 105~. Muscle power of elbow flexion was M3 to M4. Hand function was near normal. For the 7 patients with injuries at the elbow or forearm level, bone healing was achieved for the transferred bone flaps. There was partial recovery of the hand function. Conclusion In the management of complex tissue defect and vascular damage of the upper extremity, emergency composite tissue transfer at the same stage of vascular repair can effectively cover the wound, increase the survival rate of the compromised limb,and provide good soft tissue bed for secondary functional reconstruction.
出处
《中华手外科杂志》
CSCD
北大核心
2010年第1期7-10,共4页
Chinese Journal of Hand Surgery
关键词
外科皮瓣
创伤和损伤
移植
显微外科手术
Surgical flaps
Wounds and Injuries
Transplantation
Microsurgery
