摘要
[目的]探讨手部严重组织缺损急诊修复与功能重建的方法。[方法]在急诊时采用自行设计的皮瓣、组织瓣对拇指(或2～3指)合并虎口、手背、手掌大面积皮肤缺损采用第2(2～3)足趾携带踝前皮瓣、足背扩大皮瓣,行拇(2～3)指再造、虎口开大成形及手掌、手背或手前臂大面积皮肤缺损修复15例及第2足趾或拇甲瓣加组合皮瓣移植再造拇指及同时修复虎口、手背、手掌或前臂皮肤缺损252例;手掌尺侧、手掌尺腕侧骨骼与肌肉缺损或合并前臂大面积皮肤缺损采用巨大胸脐皮瓣或携带腹直肌的胸脐皮瓣修复与重建372例;全手脱套伤皮肤缺损的修复采用吻合肩胛下血管的肩胛侧胸联合皮瓣,用侧胸皮瓣覆盖手背创面,肩胛部皮瓣覆盖手部掌侧创面,缝成袋状完全能包裹手部或手部合并前臂创面18例。[结果]本组吻合血管的游离皮瓣、组织瓣有7例发生血管危象,经探查与重新吻合后均成活。术后伤口一期愈合619例,38例二期愈合。随访1～15年,按中华医学会手外科学会上肢部分功能评定标准评定,结果属优340例,良228例,可65例,差24例,优良率86.5%。[结论]手部严重组织缺损急诊采用显微外科技术修复与一期功能重建能获得较好的效果。
[Objective]To approach the methods of emergency microsurgery repair and one stage functional restoration in tretment of severe tissue defect of the hand. [ Method] Fifteen cases of large skin compounded defects of thumb, hukou, back of hand and palm were repaired with second toes along with anterior malleolus flap, and extend flap of dorsum of foot. Two hundreds and fifty - two cases of compounded defects of hukou＇, back of hand palm and forearm were repaired with second toes or big nail skin flap along with flap transplantation and thumb reconstruction. Thoracoumbilical flap was used in other 372 cases with bone and muscle defect or the big skin defect of the forearm. The lateral thoracic flap and scapular flap was used in repair of 18 cases of the avulsion of the hand. The lateal thoracic flap covered the raw surface of the back hand, the scapular flap covered the raw surface of the palm, so as to completely wrap up the hand or the hand complic forearm. [ Result] Seven cases were found vessel crisis in the free skin flap and tissue flap, they all survived after surgical exploration and reanastomosis of blood vessel. One stage healing was gained in 619 cases, two stage healing was gained in 38 cases. All cases were followed up for 1 - 15 years. According to the criteria of upper limb of C. M. A hand surgery institute, there were excerllent in 340 cases, good in 228 cases, fair in 65 cases, bad in 24 cases, with the satisfactory rate of 86.5%. [ Conclusion] It is an effective method of emergency microsurgery repair and one stage functional restoration in tretment of severe tissue defect of the hand.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2008年第2期111-114,共4页
Orthopedic Journal of China
关键词
手部
显微外科
修复与重建
hand
microsurgery
repair and reconstruction
