摘要
目的探讨分指腹部真皮下血管网皮瓣、M形腹部真皮下血管网皮瓣、S形腹部真皮下血管网皮瓣精准修复手部不同软组织缺损创面的临床应用效果。方法对2016年3月-2019年6月采用三种腹部真皮下血管网皮瓣治疗的手部软组织缺损66例159块皮瓣作为观察组,另选择同期应用传统腹部全厚随意皮瓣修复类似创面38例47块皮瓣作为对照组。术后密切观察皮瓣血运,断蒂后观察皮瓣的外形、颜色、温度、质地、感觉恢复、手功能恢复以及是否需要行皮瓣修薄术及皮瓣分指术等。将观察组和对照组的上述各项指标进行比较,并将观察组术后12个月的皮瓣感觉功能恢复评分和手功能评分分别与对照组进行统计学分析,确定三种真皮下血管网皮瓣修复手部不同创面的临床疗效。结果观察组159块真皮下血管网皮瓣全部成活,断蒂后皮瓣外形良好,厚薄适宜,质地柔软,不需再行皮瓣修薄及皮瓣分指术。对照组47块皮瓣全部成活,6块皮瓣出现局部坏死,经多次清创后最终成活,大部分皮瓣外形臃肿还需行皮瓣修薄及分指术。采用三种真皮下血管网皮瓣治疗的患者术后12个月手功能优良率分别为85%、83%、86%;38例传统腹部全厚随意皮瓣的优良率为74%。将观察组皮瓣感觉功能恢复评分和手功能评分分别与对照组进行对比,感觉功能恢复差异无统计学意义(P=0.680,P=0.747,P=0.962),手功能评分差异有统计学意义(P=0.004,P=0.018,P=0.010)。结论相对于传统腹部全厚随意皮瓣,三种腹部真皮下血管网皮瓣可以做到精确修复手部不同软组织缺损创面,减少了手术次数,皮瓣外形好,术后可早期进行功能训练,值得临床推广应用。
Objective To explore the clinical application effects of split-finger abdominal subdermal vascular network flaps,M-shaped abdominal subdermal vascular network flaps,and S-shaped abdominal subdermal vascular network flaps to accurately repair different soft tissue defects in the hand.Methods A total of 66 patients 159 skin flaps with soft tissue defect of hand treated with split-finger,M type and S type abdominal subdermal vascular network flap in our hospital from March 2016 to June 2019 were selected as the experimental group.Another 38 patients who used traditional full-thickness abdominal flaps to repair similar wounds at the same period were selected,and a total of 47 flaps were used as the control group.After the operation,paid close attention to the blood supply of the flap,observed the shape,color,temperature,texture,sensation recovery,hand function recovery and whether the flap thinning and flap fingering were needed after pedle amputation.The above observation indexes of the experimental group and the control group were compared,the sensory function recovery score and hand function score of the skin flap of the experimental group 12 months after surgery were statistically analyzed with the control group respectively,and the above indexes were comprehensively analyzed to determine the clinical efficacy of the three kinds of subdermal vascular network skin flaps in repairing different wounds of the hand.Results All 159 subdermal vascular network flaps in the experimental group survived,after pedicle flap was broken,the flap had good shape,suitable thickness and soft texture,and no further flap thinning and flap finger splitting was needed.In the control group,all 47 skin flaps survived,and 6 skin flaps showed local necrosis,and survived after repeated debridement,most of the flaps had bloated appearance,and flap thinning and finger seperation were needed.The excellent rate of hand function 12 months after operation was 85%,83%and 86%in patients treated with three kinds of subdermal vascular network flaps;t
作者
周浩
郝陆瑶
龚志鑫
ZHOU Hao;HAO Luyao;GONG Zhixin(Department of Orthopedics,The Third Hospital of Hebei Medical University,Shijiazhuang,Hebei,050051,China)
出处
《实用手外科杂志》
2022年第3期291-295,332,共6页
Journal of Practical Hand Surgery
基金
河北省卫健委青年科技课题(项目编号:1120140191)。
关键词
真皮下血管网
手部软组织缺损
外科皮瓣
Subdermal vascular network
Hand soft tissue defect
Surgical flap
