皮片修薄原位缝合治疗手掌皮肤逆行撕脱伤

目的提高手掌皮肤逆行撕脱之皮片原位缝合后的成活率，减少对身体其他部位造成的继发性损伤。方法选择３９例手掌皮肤逆行撕脱伤的患者，将撕脱皮片的近侧２／３修薄成真皮下血管网皮片，远侧１／３皮下脂肪保留，原位缝合，留置长残尾加压包扎。结果３９例中３５例撕脱皮片完全成活，４例皮片边缘小片坏死，修剪换药后痊愈。随访０．５ａ～６ａ，３例虎口轻微挛缩，余撕脱之皮片无挛缩，质地柔软，感觉恢复好。结论采用皮片修薄原位缝合治疗手掌皮肤逆行撕脱伤，撕脱皮片成活率高，外形美观，且无继发损伤，确是一种较理想的手术方法。

Suture in situ for retrograde avulsion of palmar skin by thinned skin graft

Objective To enhance the rate of success of suture in situ and diminish the secondary lesion of other sites in patients with retrograde avulsion of palmar skin,the operative technique was deviced.Methods Thirty ningh patients with retrograde avulsion of palmar skin were treated.The proximal two-thirds of avulsion was pruned and thinned,and caused it to be underdermic graft with vascular net,but reserved the subcutaneous fat at one in three of distal graft.After suture in situ,the compression bandga and the retaining longer suture-tail were used.[WT5”HZ〗Results In 39 patients treated by suture in situ with thinned skin graft,the grafts survived fully in 35 patients.The small patchy necrosis at the margin of the grafts were seen and short term recoveryies were abtained by way of pruning and dressing in 4 patients.A following-up period lasting 0.5～6 years showed that the recovery of sensitivity was quite good,and local skin was doughy and did not constructure in all but mild constructure on part of the hand between the thumb and the next finger in 3 patients.[WT5”HZ〗Conclusion Application of thinned graft and orthotopic suture in patients with retrograde avulsion of palmar skin is an optimal surgical method.Through the treatment of this surgical mehtod,the survival rates of grafts are higher and the contour of the hands are beautiful to look at.