手部多指或多处复杂性软组织缺损皮瓣Ⅰ期修复

目的探讨手部多指或多处复杂性软组织缺损皮瓣Ⅰ期修复的手术方法。方法对3指掌侧或背侧软组织缺损采用足背三叶皮瓣移植修复24例，3指脱套性缺损采用双侧足背三叶皮瓣移植修复8例，1（2）指脱套加另1（2）指软组织缺损采用足背分叶加足背三叶皮瓣移植修复10例，3指掌侧（背侧）合并手掌（手背）44组织缺损采用足背三叶加踝上形成一蒂四块皮瓣移植修复4例；4指掌侧软组织缺损采用双第2趾孪生趾腹皮瓣移植修复10例、足背三叶皮瓣加小鱼际逆行岛状皮瓣修复2例，足背三叶皮瓣加大鱼际皮瓣修复2例，4手指掌侧合并手掌软组织缺损采用一侧足背嘏趾腹皮瓣加另一侧足背三叶皮瓣移植修复2例，4手指背侧软组织缺损采用足背三叶皮瓣加掌背动脉逆行岛状皮瓣修复5例，双侧足背分叶皮瓣移植修复4例，4手指背侧合并手背软组织缺损采用足背三叶皮瓣加前臂逆行岛状皮瓣修复4例，足背三叶皮瓣加股前外侧分块皮瓣移植修复6例；5手指软组织缺损采用一侧足背分叶皮瓣加另一侧足背三叶皮瓣移植修复2例。结果本组其它皮瓣均顺利成活；但足背三叶皮瓣63例71块，3块一叶坏死，1块二叶坏死；足背三叶加踝上皮瓣形成一蒂多块皮瓣4例，其中1例踝上皮瓣少许坏死，皮瓣坏死区经扩创术后换药植皮愈合。结论最大限度利用不同种类的足部皮瓣加股前外侧分块皮瓣以及手部、前臂的岛状或游离皮瓣做瓦合或联合移植，可Ⅰ期修复手部多指或多处复杂性软组织缺损。

Clinical application of using different kinds of flaps to repair defects of multi-fingers or complex defects of hand

Objective To explore clinical application of using different kinds of flaps to repair defects of multi-fingers or complex defects of hand.Methods 24 cases of 3 fingers with dorsal or volar defect were treated with trifoliated flap;8 cases of 3 fingers with avulsed defect were treated with bilateral trifoliated flap; 10cases of finger avulsion and skin defect of other finger were .treated with splitting dosum flap combined with trifoliated flap;4 cases of 3 fingers and hand with volar or dorsal defects were treated with trifoliated flap combined with anterior superior malleolus flap.10 cases of 4 fingers with volar defects were treated with trifoliated flap combined with retrograde small thenar island flap;2 cases were treated with trifoliated flap combined with great thenar flap; 2cases of 4 fingers and palm with volar defect were treated with one-side dorsum flap combined with side-pulp flap plus another-side trifoliated flap;5 cases of 4finger with dorsal defect were treated with trifoliated flap combined with dorsal metarcarpal flap. 4cases were treated with double sublob flap from dorsum of foot.4 cases of finger and palm with dorsal defect were treated with combined with retrograde island flap of forearm; 6 cases were treated with combined with femoral anterior-laterial splitting flap; 2 cases of 5 fingers with skin defect were treated with one-side splitting dosum flap combined with another-side trifoliated flap.Results All flaps surrived completely except 4 cases.63 cases of trifoliated flap with 71 pieces of flaps were used,one piece in 3 cases necrosed, two pieces in 1 case necrosed.4 cases of trifoliated flap combined with anterior superior malleolus flap were used, and anterior superior malleolus flap in one case necrosed partly.Conclusion Different kinds of flaps from foot combined with femoral anterior-laterial splitting flap or other flaps from hand or forearm should be used to repair simultaneously defects of multi-fingers or complex defects of hand.