摘要
目的探讨复合肌腱的前臂内侧皮神经营养血管皮瓣修复小儿手部缺损的疗效。方法2019年10月至2021年12月,我科收治19例手部皮肤缺损患儿,其中男11例,女8例;年龄9~16岁,平均14岁。外伤16例,伤后至手术时间2~8 h,平均3.5 h;脱套伤术后创面2例;虎口挛缩切除术后1例。缺损部位:手背尺侧4例,手掌桡侧7例,手掌尺侧5例,拇指桡掌侧2例,虎口1例。19例均伴骨质、肌腱等外露或缺损。创面范围为3 cm×3 cm~12 cm×8 cm。采用大小为3.0 cm×3.6 cm~13.2 cm×9.1 cm复合肌腱的前臂内侧皮神经营养血管皮瓣修复,其中11例前臂内侧皮神经与受区皮神经吻合。供区直接拉拢缝合或植皮修复。结果2例皮瓣术后远端部分坏死,经换药4周后愈合;其余17例均成活。供区切口均Ⅰ期愈合,植皮成活。19例皮瓣术后均获5~30个月随访,平均12个月。皮瓣质地良好,外观满意。末次随访时,皮瓣感觉恢复达S2~S3+;其中11例吻合皮神经皮瓣感觉达S3~S3+,优于8例未吻合皮神经皮瓣的S2~S3。19例行复合部分尺侧腕屈肌腱桥接移植修复者,手部肌腱功能恢复满意,末次随访时仅3例总主动活动度>健侧80%。末次随访时根据中华医学会手外科学会功能评定标准,优16例,良3例。结论复合肌腱的前臂内侧皮神经营养血管皮瓣既能修复小儿手部缺损,又能重建患肢功能,是修复小儿手部缺损的有效方法之一。
Objective To investigate the effect of repairing children’s hand defects with the combined tendon of forearm medial cutaneous nerve nutrient vascular flap.Methods From October 2019 to December 2021,19 children with hand skin and soft tissue defects were admitted.There were 11 males and 8 females.The age ranged from 9 to 16,with an average age of 14.The time from injury to operation was 2-8 h(mean 3.5 h)in 16 cases.Two cases were of ungloved injury;one case was after the resection of contracture of tiger mouth.Defects:4 cases on the ulnar side of the hand,7 cases on the radial side of the palm,5 cases on the ulnar side of the palm,2 cases on the radial palmar side of the thumb,and 1 case on the tiger mouth.All the 19 cases were accompanied by bone and tendon exposure or defects.The wound range was 3 cm×3 cm-12 cm×8 cm.Nutritional vascular flaps of medial forearm cutaneous nerve with a combined tendon size of 3.0 cm×3.6 cm-13.2 cm×9.1 cm were used for repair,and the medial forearm cutaneous nerve was anastomosed with the receiving area cutaneous nerve in 11 cases.Donor area direct suture or skin graft repair was applied.Results The distal part of the skin flap was necrotic and healed 4 weeks after dressing change.All the other 17 patients survived.The donor incision and wound healed in stageⅠand the skin survived.All the 19 cases were followed up for 5-30 months,with an average of 12 months.The skin flap has good texture and satisfactory appearance.At the last follow-up,the sensory recovery of the flap was S2-S3+.The sensation of 11 cases with anastomotic cutaneous nerve flaps was S3-S3+,which was better than S2-S3 of 8 cases without anastomotic cutaneous nerve flaps.The tendon function of the hand recovered satisfactorily in 19 patients who underwent composite part bridge transplantation of flexor carpi ulnar tendon.Only 3 patient had total active motion>80%of the healthy side at the last follow-up.At the last follow-up,16 cases were excellent and 3 cases were good according to the functional evaluation cr
作者
张荐
王斌
杨焕友
ZHANG Jian;WANG Bin;YANG Huan-you(Department of Joint Surgery 3,The Second Hospital of Tangshan,Heibei,063000,China)
出处
《中国骨与关节杂志》
CAS
2024年第5期372-375,共4页
Chinese Journal of Bone and Joint
关键词
外科皮瓣
组织移植
腱
修复外科手术
Surgical flaps
Tissue transplantation
Tendons
Reconstructive surgical procedures
