保留残指指骨与甲床联合皮管一期再造手指8例分析

目的：探讨软组织严重毁损无再植条件的末节离断的手指再造方法。方法：利用残指指骨与甲床联合腹部带蒂管状皮瓣移植再造软组织缺损严重的离断手指。结果：本组8例利用残指指骨与甲床联合腹部带蒂管状皮瓣移植再造拇手指皮瓣全部成活6例,1例甲床部分坏死,1例甲床完全坏死。术后随访2～12个月,再造拇手指成活良好,外形美观,功能良好,患者满意。结论：此方法利用废弃的指骨与甲床重建手指,适用于无再植条件的末节离断伤,残指指骨与甲床一体移植,操作简单、成活率高,再造手指外形和功能恢复良好,易于患者接受。     

同指血管神经蒂皮瓣加废弃指骨甲床再造末节手指6例

目的:报告同指血管神经蒂皮瓣加废弃指骨甲床再造末节手指的临床效果.方法:将已断离废弃的末节手指,保留末节指骨及甲床,回植于断指残端,以残端一侧带血管、神经蒂的皮瓣完全包裹末节指骨及甲床再造末节手指6例.结果:再造手指全部成活,术后随访2-6个月,再造之末节手指色泽、质地、感觉均良好,功能恢复佳,部分已有新甲生长的倾向.结论:本法再造末节手指是一种简便易行,成功率高的方法,不伤及健指,外形美观、逼真.     

游离足趾移植联合皮瓣移植手指再造患者的围手术期护理

目的探讨游离足趾移植联合皮瓣移植再造的术后护理。方法对8例手指缺损并伴有皮肤软组织缺损的患者采用足趾移植联合皮瓣移植进行手指再造,行积极有效术前、术后心理疏导,解释手术风险和手术难度,引导患者积极配合术后治疗。术后做好常规护理,严密观察再造指及皮瓣血液循环情况,及时发现并处理动脉、静脉血管危象,警惕足部及皮瓣供区的皮肤软组织感染。结果 8例患者术后再造指及皮瓣均成活;2例出现动脉危象,及时干预后危象均得到解除。所有再造指及皮瓣均成活,术后再造指及皮瓣外观满意。结论充分的术前准备,积极有效的术前术后心理护理,全面严密的术后观察及护理措施是确保术后再造手指顺利成活的关键,早期康复利于再造指获得良好功能。     

改进的前臂逆行岛状皮瓣在手部创伤中的作用

将前臂逆行岛状皮瓣改进,血管蒂转动点由原来的腕横纹处向远侧游离到1、2掌骨间,切取前臂远侧1/3皮肤修复包括手指末端在内的手指皮肤或骨皮肤缺损。1985年6月～1986年10月我科应用该方法治疗手、手指皮肤撕脱伤、手指严重复合组织损伤、无再植适应证的复杂断指及再植失败者23例,获得了满意的疗效。伤后入院时间最长者72小时,最短者1小时。入院后均在臂丛麻醉下急行清创术,然后应用改进的前臂逆行岛状皮瓣或骨皮瓣修复创面或再造手指,或者     

血管束植入预构骨皮瓣的实验研究

目的 通过建立1个血管束植入预构骨皮瓣的动物实验模型,探讨血管束植入后的预构骨皮瓣的形成及变化过程,为预构骨皮瓣临床应用提供实验依据.方法 将40只新西兰兔随机分成5组,移植右髂骨块于颈单蒂任意皮瓣下方,形成骨皮瓣,各组动物随机分为实验组和对照组各4只.实验组切开骨皮瓣翻起,仅保留血管束作为蒂部,再原位缝合.对照组皮瓣切开翻起后重新缝合.分别于植入后第2、3、4、5、6周,观察和监测皮瓣的成活与骨皮瓣吸收情况及组织学变化.结果 同期植入血管束的骨皮瓣与任意骨皮瓣相对比,植入血管束的预构骨皮瓣成活情况好,骨组织无坏死及吸收(P＜0.01).结论 血管束植入具有加速血运重建,保持骨组织结构稳定,无吸收的优点.     

Flow-through踇趾腓侧皮瓣游离移植修复断指再植

背景：断指再植损伤性质不同,组织损伤各异,单纯的组织或者血管、神经损伤用传统的邻指、腹部皮瓣等可以覆盖创面,容易修复,但时间长,需2次手术,外形患者不满意。目的：探讨Flow-through踇趾腓侧皮瓣游离移植在断指再植中的修复效果。方法：2011年1月至2013年10月应用Flow-through踇趾腓侧皮瓣游离移植修复合并软组织缺损的断指11例,其中男8例,女3例;年龄23-42岁;皮肤缺损范围2.0 cm×1.5 cm至4.0 cm×2.2 cm;血管缺损1-3 cm,平均1.5 cm;皮瓣切取范围在2.2 cm×1.7 cm至4.5 cm×2.5 cm。结果与结论：随访6-18个月,全部断指均成活。10例皮瓣一期愈合;1例皮瓣边缘部分坏死,经过换药后逐渐愈合,皮瓣外形好,色泽质地与正常手指基本相似。患指末梢两点分辨觉为4-10 mm。手指屈伸功能良好,根据中华医学会手外科分会上肢部分功能评定标准,优9例,良2例。提示Flow-through踇趾腓侧皮瓣游离移植能同时修复皮肤软组织缺损和血管缺损,对于合并有节段性皮肤软组织缺损的断指,是一种较好的修复方案。     

弹力指套对手指皮瓣移植术后肿胀的影响

手部受机械损伤后容易引起皮肤缺损,并伴肌腱、骨关节、神经血管外露,手指尤其是拇指的缺失严重影响人们的生产劳动、生活、学习和娱乐,因此,皮瓣移植修复或再造手指有其特别重要的意义。术后皮瓣的成活及外形、功能的恢复是护理的关键。     

游离拇甲皮瓣包裹异体手指手术配合

拇指和手指的再造方法很多,有皮管植骨、足趾移植、残指转位等手术,1959年起我院开始应用尸手去皮的手指综合组织经冷藏后作异体移植。虽然患者术后对再造手指使用满意,但12—20年后经X线复查发现异体指骨均有不同程度的吸收现象,这可能与血供不足和缺乏神经支配有关。根据1980年Morrisoa的报道,我院整形外科设计了用自体带神经、血管的拇甲     

多指离断再植应用冬眠疗法一例的护理

目的探讨小儿断指再植、手指再造术后血管危象的预防与治疗。方法对1例中指、示指及环指离断小儿，对其实施中、示指断指再植，环指残端修整术，术后应用冬眠合剂3d。结果示、中指成活，环指愈合良好。结论冬眠疗法可有效预防和治疗小儿断指再植、手指再造术后血管危象，提高断指再植、手指再造的成活率。     

足趾移植再造手指术后外形的整形

目的探究足趾移植再造手指术后外形的整形方法。方法选取2009年至今我院收治的50例(60指)Ⅲ~Ⅵ度手指缺损的患者,对其缺损手指采用第二足趾移植再造术,术后联合应用骨、肌腱、局部皮瓣等显微外科术进行外形整形。结果 50例(60指)移植手术均成功,术后再造指的外形也得到了一定的修复,再造指的关节活动和指腹感觉无影响,无感染并发症,功能、外形改善均满意。结论足趾再造手指术后,会出现指腹膨大,指体驼颈等畸形,可通过显微外科技术进行整形重塑,其疗效显著。     

A modified thumb spica splint for thumb injuries in the ED

There are a significant number of hand and upper extremity injuries treated in US emergency departments (EDs) each year. Many of these involve the thumb and wrist. These injuries encompass the range from fractures, strains, and sprains to more specific injuries such as gamekeeper thumb and de Quervain tenosynovitis. These injuries often require diagnosis, splinting, and referral to a hand or orthopedic surgeon. The splint described in this article is presently being used for patients with de Quervain tenosynovitis, but it may have more widespread application in emergency medicine. It is a safe and simple splint that is underused in EDs for splinting thumb injuries.     

Gamekeeper's thumb

Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint can result in significant pain and instability. Patients with this injury have severe difficulties with pinching and grasping objects. Avulsions of this collateral ligament from the proximal phalanx and midsubstance tears provide the usual mechanisms of injury. Complete ruptures usually require surgical treatment. Cast immobilization is usually satisfactory for partial tears.     

In-vivo function of the thumb muscles

OBJECTIVE: The purpose of this study is to quantify the electrical activity of the thumb muscles responsible for the production of force in different directions of thumb movement. DESIGN: The isometric forces and electromyographic activity generated by seven thumb muscles were measured on five normal healthy test subjects. BACKGROUND: The thumb is very important for proper hand function. Presently available electromyographic studies of the thumb muscles provide only limited information. Most thumb muscles have more than one function. Additional studies are required to carefully examine and confirm the in-vivo relationship between the thumb muscle electromyogram and mechanical output. METHODS: The direction and magnitude of the force vector generated at the interphalangeal joint and the relative electrical activity were obtained for eight directions of thumb action. The regions of function were defined for the abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, adductor pollicis, flexor pollicis longus, extensor pollicis longus, and the abductor pollicis longus. Data was collected during voluntary isometric contraction, both before and after blocking the median nerve at the wrist. RESULTS: The highest force production was obtained during flexion. The region of maximal muscle electrical activity varied for each muscle studied. The areas of maximal in-vivo muscle activity agreed with the moment arm data reported in the literature. The median nerve block eliminated the ability to produce force in abduction. CONCLUSIONS: This study has demonstrated that by combining electromyographic measurement and biomechanical analysis it is possible to confirm the relationship between in-vivo thumb muscle function and muscle mechanics in a novel manner. The findings of this study indicate the importance of the local anatomy in controlling the direction of force production.     

Arthritis of the base of the thumb

The purpose of this article is to outline the pathophysiology and epidemiology of arthritis of the base of the thumb. The usual presentation and diagnosis will be discussed along with the current conservative treatment options. Surgical treatment options are determined by the stage of the arthritis as well as the demands of the patient. The current standard surgical treatment options will be reviewed along with their results in the literature.