摘要
目的探讨手部皮神经营养血管逆行皮瓣术后并发症的防治。方法对83例手指和手掌、背创面，采用六种皮神经为轴线设计的皮神经营养血管逆行皮瓣进行修复。其中指神经背侧支皮瓣16例；指背皮神经皮瓣6例；桡神经浅支，包括拇指桡或尺背侧皮神经皮瓣42例；尺神经手背支皮瓣10例；前臂内侧或外侧皮神经皮瓣9例。在皮瓣设计、切取、转移和术后处理方面采取了一系列综合措施防治术后并发症的发生。结果术后全部皮瓣均存活，但在随访中发现皮瓣供、受区均存在不同程度的并发症：如受区皮瓣静脉回流障碍，皮瓣或蒂部臃肿；供区存有植皮区失活，伤口瘢痕增生，神经瘤形成或虎口轻度挛缩。通过后期注重对皮瓣和蒂部无张力的缝合、皮瓣二期整形等综合措施，有效地降低了并发症的发生。结论加强皮神经营养血管皮瓣转移术各个环节的精细操作，尽可能矫正皮瓣对手部美观造成的负面影响，才能降低该类皮瓣修复手部创面的术后并发症，提高患者的满意度。
Objective To explore the complications and their management after application of reverse neurocutaneous flaps to cover soft defects in the hand. Methods Eighty-three cases with soft tissue defects in the thumb, fingers, dorsum or palm of the hand were treated with 6 types of reverse neurocutaneous flaps. The flaps were designed using the cutaneous nerve close to the soft tissue defect as the axis. Six cutaneous nerves were used： dorsal branch of the digital nerve in 16 eases, the dorsal digital nerve in 6 cases, the radial superficial nerve including the dorsomdial or dorsoulnar thumb digital nerve in 42 cases, ulnar nerve dorsal branch in 10 cases, and the medial or lateral antebmchial nerve in 9 cases. To prevent and manage complications, an integrated approach was used taking into consideration flap design, harvesting, transportation and postoperative treatment. Results All the flaps survived. Complications in the recipient and donor sites were found to certain extent In the recipient site, venous congestion and bulky flap were seen. And in the donor site, the complications included loss of skin graft, hypertrophic sear, neuroma formation and mild contmeture of the first web space. After an integrated management including tension-free closure of the wound, secondary flap and scar revision, the complication rate was significantly reduced. Conclusion Precise manipulation in each step of neurocutaneous flap transfer and correction of the negative impact on the hand appearance can reduce the complication rate and improve the patients＇ satisfaction.
出处
《中华手外科杂志》
CSCD
北大核心
2009年第6期351-353,共3页
Chinese Journal of Hand Surgery
关键词
外科皮瓣
手
手术后并发症
皮神经
Surgical flaps
Hand
Postoperative complications
Cutaneous nerve
