足背复合串联皮瓣修复手掌贯通伤

目的　介绍应用足背复合串联皮瓣修复合并组织缺损手掌贯通伤的方法。方法　 2 0 0 1年 1月 -2 0 0 3年 9月 ,对 7例严重手掌贯通伤 ,应用足背串联双叶皮瓣携带趾伸肌腱、跖背皮神经和自体髂骨植骨进行移植修复。结果　皮瓣全部成活 ,经 6个月～ 3年随访 ,手部外形满意 ,皮瓣质地柔软 ,两点分辨觉达 6～ 8mm ,植骨完全愈合 ,手指运动TAM达健侧 75 %。结论　应用足背复合串联皮瓣加植骨 ,可同时修复手掌、背侧皮肤软组织、骨、肌腱和神经的缺损 ,为治疗严重手外伤提供了一种有效 ,简单的手术方法。

Repair of palm penetrating wound with microsurgical composite dorsalis pedis flap

ObjectiveComposite dorsalis pedis flaps including tendons and cutaneous nerves and free iliac bone graft were designed to accomplish one stage repair of penetrating hand injury.MethodsTwo flaps both pedicled on dorsalis pedis artery were designed, one proximal and one distal with a segment of vessel and its soft tissue investment in betweeen. The extensor digitorum tendons and dorsal cutaneous nerves or the superficial peroneal nerve were included in the flap. This composite dorsalis pedis bifoliate flap was used to treat 7 cases of penetrating hand injuries with bone, tendon and nerve loss and skin defect on both palm and dorsal aspects of the hand. Free iliac bone graft was done to bridge metacarpal defect. The bifoliate composite transplants were then put in place, one flap on the palm, one on the dorsum, the vessel segment inserted in the inter metacarpal space, and the tendons and nerves sutured to their counter parts.ResultsAll of flaps survived. Follow-up period ranged from 6 months to 3 years. Bone healing was achieved in all cases. 2 point discrimination recovered to 6 8mm. Total active range of motion of the fingers reached 75% of the normal side. Both appearance and texture of the flaps were good.ConclusionBy combining free bone graft and composite bifoliate dorsalis pedis flap transfer, one could achieve one stage reconstruction of severe hand injury with bone, tendon and nerve loss and skin defect on both sides. It is a good option for management of penetrating wound of the hand.