摘要
目的 探讨应用旋股外侧动脉降支预构复合组织瓣异位寄养再植治疗复杂拇指旋转撕脱伤的技巧、方法和优缺点。方法 回顾性分析2015年7月—2019年1月解放军联勤保障部队第九二〇医院骨科收治的拇指严重旋转撕脱伤并软组织缺损患者3例。男性2例,女性1例;年龄19~34岁,平均24.7岁;搅拌机绞伤1例,皮带轮绞伤1例,石头挤压牵拉伤1例。术前经过周密设计手术方案,应用旋股外侧动脉降支对断指一期行皮瓣预构并异位寄养再植于大腿外侧,皮瓣和断指组成的复合组织瓣成活后,二期行复合组织瓣回植修复重建旋转撕脱伤拇指及软组织缺损。结果 3例严重旋转撕脱伤的拇指经过一期预构皮瓣异位寄养再植,二期复合组织瓣回植全部顺利成活,经过1~5年随访,皮瓣有轻~中度臃肿,色泽与周围皮肤无明显色差,质地柔软,感觉良好。2例患者拇指屈伸及对指、对掌功能良好,外展轻度受限,感觉恢复为S2~S3,1例患者拇指掌指关节僵直,屈伸功能可,对指功能可,对掌功能受限,感觉恢复为S2,患者满意。按照顾玉东(2000年)断指再植评定标准,良2例,可1例,优良率66.7%。结论 应用旋股外侧动脉降支预构复合组织瓣异位寄养救治复杂拇指旋转撕脱伤可行,拓宽手指严重撕脱伤并软组织缺损的治疗方案和思路,有一定的特点和优势。
Objective To investigate the techniques,methods,advantages and disadvantages in the treatment of ectopic implantation by heterotopic replantation using composite tissue prefabricated flap through descending branch of the lateral femoral circumflex artery.Methods From Jul.2015 to Jan.2019,3 patients(2 males and 1 female aged 19-34 years,with 24.7 years on average;there was 1 case of stirrer wringing injury,1 case of belt pulley wringing injury and 1 case of squeezing and pulling injury by stone)with severe rotational avulsion of thumb and soft tissue defect were admitted.After careful preoperative surgical design,the lateral femoral artery descending branch was used for prefabricated composite tissue flap and to replant the amputated fingers in first stage.In the second stage,the combined tissue flap was transplanted to reconstruct the rotated avulsion thumb and soft tissue defect.Results Three cases with severe rotational avulsed thumb were all survived through replanted with ectopic preconstructed flap in the first stage,followed by composite flap replanting in the second stage.After 1-5 years of follow-up,the replanted thumb recovered to relatively satisfactory function,soft texture and good feeling.There was no obvious color difference compared with surrounding skin.Two patients had good thumb flexion and extension function,good opposing finger and palm function and but mild limitation of abduction,and the sensory recovered to S2-S3.One patient achieved rigid thumb and metacarpophalangeal joint,fair flexion and extension function,fair opposing finger function but limited opposing palm function,and the sensory recovered to S2.The patient was satisfied.According to Gu Yudong's(2000)evaluation standard for replantation of severed finger,2 cases were good and 1 case was fair,with an excellent and good rate of 66.7%.Conclusion It is feasible to treat complex rotation avulsed thumb by ectopic implantation of composite tissue prefabricated flap through descending branch of the lateral femoral circumflex artery.It bro
作者
王腾
何晓清
徐永清
宗海洋
杨曦
范新宇
蔡兴博
陈延岭
Wang Teng;He Xiaoqing;Xu Yongqing;Zong Haiyang;Yang Xi;Fan Xhvyu;Cai Xingbo;Chen Yanling(Department of Orthopedics,The 920th Hospital of the Joint Logistics Support Force of PLA,Kunming 650032,China)
出处
《创伤外科杂志》
2022年第6期416-419,427,共5页
Journal of Traumatic Surgery
基金
全军后勤科研计划面上项目(CCD14J003)
全军后勤科研计划重大专项(AWS14C003)。
关键词
拇指撕脱伤
旋股外侧动脉降支
预构皮瓣
异位寄养
再植
thumb avulsed injury
descending branch of the lateral femoral circumflex artery
prefabricated flap
ectopic implantation
replantation
