改良"海鸥"形皮瓣治疗指蹼粘连畸形效果分析

目的探讨改良"海鸥"形皮瓣治疗指蹼粘连畸形的效果。方法选取2015年1月至2017年5月指蹼粘连畸形患者22例39个指蹼,给予改良"海鸥"形皮瓣修复、重建指蹼。结果 22例患者皮瓣均成活,且无坏死及血液运行障碍现象,重建指蹼大小、深度均与正常指蹼相似,其中36处指蹼直接缝合,23处植皮修复。结论改良"海鸥"形皮瓣可有效修复第2～4指指蹼、指蹼背侧蹼状畸形粘连,因其充分利用指蹼背侧的蹼状结构,且手指中心部没有缝合线,术后瘢痕挛缩少,外形美观。     

腱鞘交错切开减压在治疗复发性并指畸形中的应用

目的:探讨腱鞘交错切开减压在治疗复发性并指畸形中的临床效果.方法:对26例复发性并指畸形的患者,常规在并指的连接处或挛缩部切开减张松解后,在指骨干掌侧避开近侧指间关节、远侧指间关节和掌指关节处,分别作横切口切开屈肌腱鞘,指侧方作纵形切开腱鞘,但不切除腱鞘,并与横切口连成"Z"形.松解彻底后,各腱鞘关节部横切口错位缝合.再常规作指侧方植皮和指蹼成形术,但腱鞘侧方切开处不植皮.结果:所有切口均Ⅰ期愈合,皮瓣、指端血循良好.1例植皮区部分粘连,1例轻度屈曲畸形.术后随访半年至1年半,各患指外展达50°左右,外形和指屈伸功能已恢复正常或接近正常.结论:腱鞘交错切开减压在治疗复发性并指畸形中,较有效地解决了肌腱的粘连和恢复问题,临床效果理想,值得推广应用.     

预制指背筋膜蒂皮瓣重建近指间关节重度屈曲挛缩的临床应用

目的探讨同指逆行指背筋膜蒂皮瓣修复重建近指间关节屈曲挛缩松解后的创面的方法与疗效。方法2012年5月至2014年5月对10例近指间关节重度屈曲挛缩患者行肌腱、血管及神经彻底松解后,应用预制同指逆行筋膜蒂皮瓣修复,皮瓣切取面积1.8 cm×2.2 cm~2.8 cm×3.2 cm,供区创面植皮。结果术后10例皮瓣及植皮均成活,其中2例皮瓣远端局部缺血坏死,换药后创面愈合。术后随访3~6个月,皮瓣饱满,颜色红润,质地柔软,弹性好,无色素沉着,无瘢痕挛缩。术后9指功能满意,1指因伸肌腱止点早期损伤疗效欠佳。结论采用预制指背筋膜蒂皮瓣重建近指间关节屈曲挛缩畸形,操作简单,不损伤主要血管,供区损伤小,是一种重建近指间关节重度屈曲挛缩的理想方法。     

远指间关节背侧肌腱及皮肤缺损11例治疗体会

目的:探讨远指间关节背侧肌腱及皮肤缺损的治疗方法。方法:对11例远指间关节背侧组织缺损伴伸肌腱(及止点)缺损患者采用微型骨锚钉联合掌长肌腱移植重建伸肌腱止点加皮瓣修复术治疗。结果:术后随访5~18个月所有患者均未发生创口感染及骨锚植入后异物反应。1例4个月后患指下垂,二期行关节融合。手功能评定标准采用Dargan功能评定法:优5例,良4例,可1例,差1例,优良率达81.82%。结论:采用微型骨锚钉联合掌长肌腱移植重建伸肌腱止点加皮瓣修复术治疗远指间关节背侧肌腱及皮肤缺损,能取得良好疗效,是一种值得推广的治疗方法。     

并指间皮肤牵张器治疗儿童并指畸形的一期手术护理

目的探讨并指间皮肤牵张器治疗儿童并指畸形的术中护理方法。方法回顾我院采用自行设计、研制的“并指间皮肤牵张器”治疗13例儿童并指畸形的术中护理。包括临床资料、术前准备、术中护理、术后护理，巡回、器械护士术中护理要点。结果13例一期均顺利采用并指间皮肤牵张器行并指间皮肤软组织牵张，二期行并指分离术时均不需要游离植皮，指蹼重建满意，几无瘢痕，近期的临床外观满意。结论规范、熟练的术中护理是手术成功的可靠保证，不但可以缩短手术时间，而且还可以减少切口感染率的发生。     

伸指腱延长修补重建陈旧性手指扩张部断裂畸形

1984年7月～1987年10月,我院先后收治陈旧性手指扩张部断裂畸形用伸指腱修补重建7例,现总结报告如下。1 临床资料1.1 一般资料 7例患者均为女性,年龄17～35岁,病史2～4年。均为左掌指扩张部切割伤,中指6例,无名指1例,因治疗不当而影响正常功能。1.2 方法与结果 术前常规备皮,在掌指关节背侧横切开约2cm,找出该指的伸指腱;腕关节背侧切开,找出该指腱切断游离;近侧端用丝线牵引;远侧端经指掌关节切口拉出,左右各半纵形切开至掌指关节附着部,桡侧半经原皮下隧道送还与近端行端端吻合。于中指近侧指间关节背侧作U形切开并游离皮瓣;复位中指近侧指间关节,在中指骨远端中1/3处横行钻孔至对侧,经近侧指骨背侧正中皮下隧道将     

微型软组织扩张器治疗并指畸形患儿的护理

我国新生儿先天性手畸形的发病率为0.0808%[1],其中先夫性并指的发病率仅次于复拇指畸形,居第2位.皮片移植一直是先天性并指畸形的传统手术方法,但常易出现并发症.皮肤扩张器是一种类似气球形状的硅胶囊,由扩张囊、注射壶、导管组成,通过注射壶向扩张囊内注水,使扩张囊逐渐膨胀以达到扩张皮瓣的作用.现用一种治疗小儿先天性并指畸形的新方法,即采用微型软组织扩张器扩张指间皮肤,皮瓣修复并指间皮肤缺损,并对患儿实行精心护理,取得了良好的疗效,现报道如下.     

足趾游离移植再造手指术后康复治疗分析1例

<正>1临床资料患者,女,21岁,于2011年12月17日工作时不慎被机器碾压伤右手。诊断为:右手掌、手背皮肤撕脱伤,右示指近指间关节脱位,关节囊破裂,中指中近节指骨骨折、环指近节指骨骨折,右1³指总动脉、神经断裂,23指总动脉、神经断裂,2⁵指双侧指动脉神经断裂。受伤后3日行:右手25指双侧指动脉神经断裂。受伤后3日行:右手2⁵指截指移植右足第2趾(带足背皮)再造右示指并修复手背创面,手掌创面植皮,腹部取皮右足背植皮,足拇指背"U"型皮瓣修复1、3趾趾蹼。右手手术后1月余来我院进行中后期康复治疗。     

烧伤后手指和指蹼挛缩畸形的治疗及功能康复

目的：探讨烧伤后手指和指蹼挛缩畸形的手术治疗和功能康复方法。方法：本组33例45只伤手，采用瘢痕切除或切开加皮片移植术修复127个手指挛缩畸形，采用局部皮瓣或皮片移植术分别修复36只和60只指蹼畸形。手术后早期进行关节功能训练、按摩、弹力手套压迫等康复治疗。结果：皮片移植和皮瓣全部成活，手指间关节和掌指关节功能、指蹼功能均有改善，皮瓣法修复指蹼优于皮片法。通过功能康复治疗，87．9％患者生活能够完全或大部分自理。结论：对烧伤后手指瘢痕挛缩畸形采用手术和功能康复治疗可取得较好的效果，手指侧方皮瓣修复指蹼畸形，手术简单可靠．效果好。     

拇指尺背侧动脉逆行皮瓣修复拇指远节软组织缺损临床疗效观察

我院接收拇指尺背侧动脉逆行皮瓣修复拇指远节组织缺损手术的患者30例,该手术皮瓣设计以拇指尺背侧动脉的体表投影线为轴心线,以距离甲沟2.3cm处轴线向背侧动脉穿支为旋转点,皮瓣面积为1.5cm×2.0cm～2.0cm×3.5cm。结果通过拇指尺背侧动脉逆行皮瓣修复拇指远节组织缺损手术治疗后,30例皮瓣完全成活。随访3个月～2年,随访期间,患者患指指间关节活动与腱侧相同;患者对拇指外形均比较满意,皮瓣色泽和融合程度良好,患指没有硬肿或者活动障碍。拇指尺背侧动脉逆行皮瓣修复拇指远节组织缺损手术的可行性和效果均良好,该术式创伤较小,皮瓣血供可靠,对供区的功能损害较小,功能恢复良好。     

掌背皮神经营养血管蒂岛状皮瓣修复手指软组织缺损

目的总结分析用掌背皮神经营养血管蒂逆行岛状皮瓣修复手指软组织缺损的疗效。方法2005年6月至2008年5月应用掌背皮神经营养血管蒂逆行岛状皮瓣治疗手指软组织缺损30例,其中男21例,女9例;30例中拇指末节缺损6例,拇指指背缺损4例,食指指腹缺损5例,中指指腹缺损3例,示、中指指背软组织缺损各5例,环指指背软组织缺损2例。急诊手术27例,择期手术3例。皮瓣最大面积5．0cm×3．5cm,最小面积3．0cm×2．5cm。结果28例皮瓣成活良好,2例皮瓣术后2～3d出现暗紫、肿胀、结痂,经对症处理脱痂后成活;经5～12个月随访,手指外形和功能恢复满意。结论掌背皮神经营养血管蒂逆行岛状皮瓣血供可靠,不损伤知名血管,操作简单,是修复手指软组织缺损较理想的皮瓣。     

Perforator-based reverse radial forearm flap to reconstruct multiple third-degree burn defects of the fingers.

Adequate soft-tissue coverage is a cornerstone for successful hand reconstruction in burn patients allowing for hand mobilization and rehabilitation. Multiple finger injuries that involve separate soft-tissue defects with complex wounds challenge the reconstruction dilemma. In this case report, a modified application of reverse radial forearm flap for the simultaneous reconstruction of multiple separate finger defects for burn cases is presented. A 23-year-old heavy industry worker is presented with a history of third-degree electrical burn of left index and middle fingers. The proximal interphalangeal (PIP) joint of the both fingers were exposed. A distally based radial forearm flap with a dimension 7.5 x 6 cm was planned. The flap was transposed to the distal defect and splitted. The bilobed flap was inset. A tendon graft is used to span the gap of extensor apparatus before insetting the flaps in both fingers. The donor defect was closed primarily. A satisfactory coverage is observed in the recipient areas. Finger functions including full range of motion of the metacarpophalangeal and PIP joints of the index and PIP and distal interphalangeal joints of long fingers were observed. The technique presented here is advantageous as it is easy to perform, covers multiple finger defects simultaneously, avoids long-term immobilization, saves the operative time, avoids microsurgery. Donor site is closed primarily and finally this approach ensures a simultaneous repair of complex wounds with multiple vital anatomical structures i.e. bone, tendon, joint, and soft tissue.     

手部随意修复皮瓣甲襞微循环的观察

背景:随意皮瓣循环的观察多通过激光多普勒血液灌流仪来完成,但未曾有过对随意皮瓣甲襞微循环进行过观察研究,而甲襞微循环是一种最为常见的外周循环检测方法.目的:通过对随意皮瓣的手指甲襞微循环进行观察,来了解皮瓣末梢微循环的变化情况.方法:选择河北医科大学第一医院烧伤整形外科收治的手部有皮肤组织缺损的患者进行随意皮瓣修复而并未进行特殊药物治疗的患者共有23 例按照皮瓣移植后受伤肢体及健康肢体指端的甲襞微循环分为皮瓣组和对照组,观察皮瓣移植后即刻、7,15 d 共3 个时相的微循环形态、流态及襻周.结果与结论:皮瓣组移植后即刻微循环在清晰度、血流速度、红细胞聚集、渗出方面均有很大的变化,发生微循环障碍.移植后7 d,两组红细胞聚集比较差异无显著性意义(P > 0.05),而清晰度、血流速度及渗出比较差异有显著性意义(P < 0.05);移植后15 d,两组在清晰度、血流速度、红细胞聚集及渗出方面差异无显著性意义(P > 0.05).提示,在临床治疗过程中,通过对指端微循环的观测,能够了解皮瓣血运建立情况,给临床皮瓣断蒂提供依据.     

Syndactyly reconstruction by a modified Cronin method

In 11 patients (1 to 28 years of age) having elective surgical release of congenital or burn syndactyly in 1982-1983, we used the modified Cronin method of web reconstruction with double opposing, inverted V-shaped flaps and full-thickness skin grafts. Postoperatively, the hands were splinted for three weeks, at which time we changed the dressing, with the patient under anesthesia. The hands were then immobilized for an additional three weeks. At the last clinic visit (13 to 20 months postoperatively) the hands were evaluated for adequacy of web space reconstruction, cosmesis, and postoperative complications. There was one partial loss of a full-thickness skin graft, which required regrafting when the patient prematurely removed his dressing. One proximal interphalangeal joint contracture required splinting. The web space reconstruction was judged adequate in all hands, and all patients and parents were pleased with the cosmetic results. This method of reconstruction gives good results and its web space reconstruction is technically easier than other methods.     

Pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size

BACKGROUNDThumb polydactyly is one of the most common congenital hand deformities, and the Bilhaut-Cloquet procedure or a modified one is often used. However, controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.AIMTo evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.METHODSFrom January 2014 to December 2020, 15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center. The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance. Subjective parents’ evaluations and functional outcomes (ALURRA and TATA criteria) were obtained. The alignment deviation, instability, range of motion (percent of opposite thumb) of the interphalangeal and metacarpophalangeal joints, and the aesthetic aspects, including circumference, length, nail size, and nail deformity, were used to assess the clinical outcomes.RESULTSThe average age of patients at the time of surgery was 13 mo, and the mean final follow-up occurred at 42 mo. An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs. An unstable interphalangeal joint occurred in one thumb. The flexion-extension arc at the metacarpophalangeal joint was good, while that at the interphalangeal joint was poor. Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs. The mean ALURRA score was 21.8 (range: 20-24), and the Tada score was 6.9 (range: 5-8). Compared with the non-operated side, the length of the operated thumb was approximately 95%, the girth was 89%, and the nail width was 82.9%. The mean ranges of motion were 62.1% of that of the unaffected thumb in the interphalangeal joint and 78.3% in the metacarpophalangeal joint.CONCLUSIONHarvesting a pedicle flap from a severed thumb is a safe and reliable procedure. Defects of the preserved thumb, such as the skin, nail, and bone, can be effectively restored using the complex tissue flap.     

手部随意修复皮瓣甲襞微循环的观察

背景：随意皮瓣循环的观察多通过激光多普勒血液灌流仪来完成,但未曾有过对随意皮瓣甲襞微循环进行过观察研究,而甲襞微循环是一种最为常见的外周循环检测方法。目的：通过对随意皮瓣的手指甲襞微循环进行观察,来了解皮瓣末梢微循环的变化情况。方法：选择河北医科大学第一医院烧伤整形外科收治的手部有皮肤组织缺损的患者进行随意皮瓣修复而并未进行特殊药物治疗的患者共有23例按照皮瓣移植后受伤肢体及健康肢体指端的甲襞微循环分为皮瓣组和对照组,观察皮瓣移植后即刻、7,15d共3个时相的微循环形态、流态及襻周。结果与结论：皮瓣组移植后即刻微循环在清晰度、血流速度、红细胞聚集、渗出方面均有很大的变化,发生微循环障碍。移植后7d,两组红细胞聚集比较差异无显著性意义（P〉0.05）,而清晰度、血流速度及渗出比较差异有显著性意义（P〈0.05）;移植后15d,两组在清晰度、血流速度、红细胞聚集及渗出方面差异无显著性意义（P〉0.05）。提示,在临床治疗过程中,通过对指端微循环的观测,能够了解皮瓣血运建立情况,给临床皮瓣断蒂提供依据。     

Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers

ObjectiveTo evaluate the efficacy of venous free thenar flaps for reconstructing palmar soft tissue defects in fingers.MethodsFrom December 2018 to October 2019, 11 patients with palmar soft tissue defects in fingers were treated using venous free thenar flaps. At the final follow-up, the range of thumb radial and palmar abduction on the injured side and opposite side was calculated. The total active movement (TAM) of the injured and opposite fingers and flap sensibility recovery were also recorded.ResultsThe mean follow-up time was 13.4 months, all flaps survived, and all wounds at the donor sites healed with no skin necrosis. At the last follow-up, the average range of thumb radial abduction and thumb palmar abduction on the injured side was 96.6% and 95.9% of the value on the opposite side, respectively. The average TAM of the injured fingers was 98.2% of the value of the opposite fingers. Sensation in the flaps was restored to grade S2 to S3.ConclusionVenous free thenar flaps can be alternatives for reconstructing palmar soft tissue defects in fingers.     

指侧方岛状皮瓣重建拇食指指腹感觉功能

目的探讨指侧方神经血管蒂岛状皮瓣在拇、食指指腹感觉功能重建中的应用价值。方法利用环、中指侧方神经血管蒂岛状皮瓣重建拇指指腹感觉 9例 ,重建食指指腹感觉 7例。结果 16例皮瓣全部成活 ,经过 6个月— 2年的随访 ,外观、质地满意 ,感觉功能S3—S3 级。结论应用环、中指侧方神经血管蒂岛状皮瓣是重建拇、食指指腹感觉功能的良好、可靠方法。     

手指皮肤软组织缺损的皮瓣修复

目的：探讨各种皮瓣对手指近、中、远节皮肤软组织缺损修复方法上的选择及应用。方法：1998年1月～2004年8月针对手指近中远节皮肤软组织缺损共99例病例分别采用6种皮瓣修复，其中包括局部血管蒂皮瓣和带皮蒂皮瓣，局部血管蒂皮瓣包括食指背岛状皮瓣、指动脉皮瓣、掌背动脉一指背动脉血管蒂逆行岛状皮瓣、邻指皮瓣、鱼际皮瓣、腹部带蒂真皮下血管网皮瓣。结果：全部成活，术后随访1～3年，皮瓣外形、血运、弹性、质地良好，手功能恢复满意。结论：手指皮肤软组织缺损的皮瓣覆盖面积相对较小，但对功能、外形、质地要求高，应根据具体情况及要求选择适宜的皮瓣修复，以期对手功能、外形恢复达到最佳。     

手部皮肤软组织缺损皮瓣修复78例效果观察

【目的】探讨应用不同的前臂背侧岛状皮瓣修复手背皮肤软组织缺损的临床效果。【方法】应用骨问背侧动脉岛状皮瓣（35例）,骨间前动脉桡侧骨皮支逆行岛状皮瓣（15例）,桡神经浅支营养血管为蒂的逆行岛状皮瓣（12例）,尺神经腕背支营养血管为蒂的逆行岛状皮瓣（8例）,桡动脉鼻烟窝皮支逆行岛状皮瓣（8例）5种不同的前臂背侧岛状皮瓣逆行转移修复78例手背皮肤软组织缺损。【结果】术后71例皮瓣完全成活,i例骨间背侧动脉岛状皮瓣,2例骨间前动脉桡侧骨皮支逆行岛状皮辩,2例桡神经浅支营养血管为蒂的逆行岛状皮瓣,2例尺神经腕背支营养血管为蒂的逆行岛状皮辩远端皮瓣部分坏死,经局部换药2～4周,创面愈合。术后经3个月至2年随访,皮瓣血运、弹性、质地良好。【结论】应用前臂背侧岛状皮瓣逆行转移修复手背部皮肤软组织缺损,手术操作简单、安全,临床效果满意。