7种皮瓣修复手掌、腕部严重损伤的临床应用

目的通过对用于修复手掌、手指、腕部严重损伤的7类皮瓣应用情况进行探讨,为选择皮瓣修复该类损伤提供参考。方法全部病例入院后及早行扩创,去除明显坏死的皮肤软组织,对于间生态组织、未断裂的坏死神经、肌腱以及坏死骨骼予以保留。依据损伤情况分别利用腹壁皮下埋置法保存严重热压伤毁损手掌6例,掌背皮神经/掌背动脉复合蒂皮瓣修复手指电击伤5例,指动脉侧支营养血管皮瓣2例,带感觉神经指动脉逆行岛状皮瓣5例,前臂皮神经营养血管皮瓣修复手掌手腕皮肤软组织缺损5例,腹部带蒂皮瓣14例,游离皮瓣修复虎口、拇、示指电击伤2例。结果37例皮瓣成活,保存严重热压伤毁损手掌6只,手指12只;1例腹部带蒂皮瓣修复手腕部高压电击伤,术后第2周,手掌坏死,遂行截肢术。1例掌背皮神经营养血管皮瓣术后血运障碍,皮瓣坏死。损伤手掌手指及功能不同程度得以保存。结论手掌、手指、腕部损伤修复应遵循保存患指、肢为首要原则,根据损伤情况,利用各种皮瓣修复。其中前臂、掌背皮神经营养血管皮瓣、指脉岛状皮瓣、胸腹部皮下埋置法等具有较高的临床应用价值。

Repair of skin defect of palm with 7 kinds of flap

Objective To provide a reference for clinic using 7 kinds of flap in restoring severe damnification of wrist, finger and palm. Methods We used subcutaneouly abdomen embedding flapto repair 6 palms injured by severe hot-press, dorsal metacarpal neurocutaneous/artery island fascial flaps to restore 5 fingers by electric injury, 5 reverse digital artery island flap with sensory nerve, 5 skin defect on wrist or palm restored with antebrachial neurocutaneous flap and 14 random abdominal flaps ,2 with the dorsum flap of the foot. Results 37 flaps were alive, injuried hands and fingers survived. 1 palm of random abdominal flap occurred necrosis 2 weeks after opeation due to venous thrombosis, 1 dorsal metacarpal neurocutaneous flap occurred putrescence. Conclusions The foremost principle of restoring severe damnification of wrist, finger and palm is to save the affected extremity and multiform kind of skin flaps can basically satisfy the need to repair skin defect of palm and can provide excellent function. The antebrachial neurocutaneous flap, digital ar- tery island flap and subcutaneous abdomen embedding were better than others.