吻合血管原位修复手部皮肤撕脱伤

目的 探讨手部皮肤撕脱伤的原位修复的具体方法及相关治疗结果,并评价该方法的实用性.方法 通过吻合血管对手部皮肤撕脱伤进行原位修复共21例.①清创后皮肤静脉与基部断端吻合,适用于撕脱皮肤中含有静脉者,本组8例;②拇指吻合动脉和静脉,而手掌侧或背侧撕脱皮肤加压包扎,适用于手掌或手背撕脱合并有拇指脱套伤,本组7例:③指根部动、静脉移植吻合,掌、背侧撕脱皮肤原位修复加压包扎,适用于全手脱套伤、皮肤撕脱至指蹼以远者,本组6例.结果 16例撕脱皮肤完全成活,4例大部分成活,其中3例为直接吻合静脉者,1例为手掌部撕脱合并拇指皮肤脱套伤者,均为掌心皮肤坏死,范围为2 cm×3 cm,二期经游离植皮而愈.1例大部分坏死,为全手脱套伤者,手指部分完全坏死,二期行截肢术.随访1.0～2.5年,20例保肢成功者手掌外观及色泽接近正常,但瘢痕比较明显,皮肤轻度萎缩,感觉S2～S3级,手指伸、屈功能满意,重返工作岗位.结论 对手部皮肤撕脱伤进行分类,采用不同的显微外科吻合血管技术,行皮肤原位回植,能取得令人满意的结果.

Vessel anastomosis for repairing in site of skin avulsion injury in hand

Objective To identify the practical microsurgical procedure for repairing in site of skin avulsion injury in hand, and evaluate the long-term following-up results. Methods From January 2001 to May 2005, 21 cases of skin avulsion injury in hand were treated in our department. The surgical procedures thumb skin was revascularized with vein graft from forearm, and the other part of injuried hand was resuffaced by the thickness skin graft taken from the original degloved skin, which was suitable for degloving injury in-graft, the dorsum and palm of hand was skin grafted by the original skin thinned, which was suitable for complete degloved injury at the proximal interphalangeal level. Results All the repaired skin were survival in 16 patients, partial necrosis occurred in 4 cases, which was severely crushed, required debridement and skin graft on the residual defect. Whole failure in 1 case, which underwent secondary amputation. Follow-up at 10-28 months shows acceptable cosmetic and sensible results, slight scarring was present on the volar as-pects of hand. The range of motion of the thumb and fingers was almost complete. All patients regained new jobs. Conclusion Individualization of mierosurgical methods for repairing in site of skin avulsion injury in hand does represent the best solution.