手部皮肤套脱伤的治疗

目的探讨手部皮肤套脱伤的治疗方法。方法2002年4月-2004年11月，治疗22例手部皮肤套脱伤患者，其中19例分别通过吻合血管、套脱皮肤修薄回植及多切口引流等方法进行修复。另有3例，因无法行套脱皮肤回植而采用腹部带蒂皮瓣修复。结果术后随访3个月-1年。19例套脱皮肤原位回植患者中，13例皮肤完全成活，4例有部分皮缘坏死，经中药换药后愈合，2例行切痂植皮术后治愈。手功能按ATN功能评分评定：优9例，良7例，中3例，优良率为84％，患者对手外形及功能满意。3例腹部皮瓣修复者，皮瓣全部成活。术后随访5个月-1年，手外形及功能明显差于皮肤原位回植者。结论尽可能地回植手部套脱皮肤，对手功能及外形的恢复具有重要意义。

Treatment of degloving injuries of the hand

Objective To introduce some methods for treating degloving injuries of the hand. Methods 22 eases of hand degloving injuries were treated between April 2002 and November 2004. 19 eases were treated by anastomosing vessels, performing subdermal vascular network flaps, or draining from mini-incisions. Another 3 eases were repaired by abdominal flaps. Results The follow-up period ranged from 3 months to I year. Degloved tissues in 13 eases of in situ replantation survived uneventfully. Other 4 eases had partial necrosis that healed after debridement and dress changing. 2 eases of skin necrosis underwent debridement and skin graft. The overall outcome of the in situ replantation was graded as excellent in 9 eases, good in 7 eases, and fair in 3 cases. The satisfactory rate was 84%. All 3 abdominal flaps survived, but the appearance and function of the hand were not satisfactory. Conclusion It is important to replant the avulsed skin for hand degloving injury whenever possible.