改良胸脐带蒂皮瓣修复手部毁损伤创面的临床效果

目的探讨改良胸脐带蒂皮瓣修复手部毁损伤创面的临床效果。 方法选取2017年10月至2021年07月解放军联勤保障部队第九一零医院烧伤整形科收治的手部毁损伤患者18例为研究对象，其中14例患者创面清创基底界限清楚后行改良胸脐带瓣皮瓣覆盖创面；4例患者一期行创面清创，清除坏死组织，保留间生态腱性组织，行负压封闭引流术5~7 d后创面基底清洁，基底可见肌腱、骨质外露，二期行改良胸脐带瓣皮瓣覆盖创面；患者术后10~14 d后行带蒂皮瓣断蒂术，其中4例合并并指患者行断蒂同时行并指分指术。观察皮瓣成活情况、手术次数、创面愈合时间、后期手部功能及瘢痕情况。 结果18例患者带蒂胸脐皮瓣断蒂后均成活，其中12例患者经2次手术创面愈合，6例患者经3次手术创面愈合；创面愈合时间为18~27 d，平均愈合时间(23.4±2.1) d；住院时间20~30 d，平均住院时间为(24.6±2.3) d。随访8~12个月，手部皮瓣质地柔软，皮温暖，瘢痕轻，外观无明显臃肿，供区瘢痕轻，受区外观功能恢复可，受区温哥华瘢痕量表评分1.2~3.5分，仅2例肥胖女性患者出院6个月后入院行皮瓣修薄术。 结论对于手部毁损伤，采用改良胸脐皮瓣移植修复与重建，能最大程度恢复手的功能，且手术操作相对简单，易于推广。

Clinical effect of modified pedicled thoracoumbilicus flap in repairing destructive injury wounds of hands

ObjectiveTo explore the clinical effect of modified pedicled thoracoumbilicus flap in repairing destructive injury wounds of hands. MethodsA total of 18 patients with destructive injury wounds of hands treated in Department of Burns of Plastic Surgery, the 910th Hospital of Joint Logistics Support Force of PLA from October 2017 to July 2021 were selected as the research objects. The patients were divided into single-procedure group (containing 14 patients) and two-procedure group (containing 4 patients). The single-procedure group were treated with modified thoracic umbilical cord flap to cover the wounds after the basal boundary of wound debridement was clear. The two-procedure group was treated with wound debridement at the first stage, to remove necrotic tissue and retain para-ecological tendonous tissue. After 5-7 days of vacuum sealing drainage, the wound base was clean with the exposed tendon and bone. The wound was covered with modified thoracicumbilical flap in the second stage. For all the 18 patients, the pedicled flaps were cut off 10 to 14 days after the operation, and 4 patients with syndactyly underwent pedicle division and syndactyly division. The survival of skin flap, operation times, wound healing time, hand function and scar were observed. ResultsThe pedicled thoracoumbilical flaps of all the 18 patients are survived after pedicle breakage with 12 patients′ wounds healing after two operations and 6 patients′ wounds healing after three operations. The wound healing time was 18-27 days, with an average of (23.4±2.1) days. The hospital stay was 20-30 days, with an average of (24.6±2.3) days. During the follow-up of 8 to 12 months, the flaps of hand had soft texture, warm skin, mild scar, and no obvious bloated appearance. The scar of the donor site was mild. And, the appearance and function of the recipient site was recovered well. The vancouver scar scale score of the recipient site was 1.2-3.5 points. There were only 2 obese female patients were admitted to the hospital for flap thinning surgery in 6 months later after discharge. ConclusionsFor destructive injury wounds of hands, the use of modified thoracoumbilical flap for repair and reconstruction can restore the function of the hand well. With the simple operation, the modified thoracoumbilical flap is worthy of clinical promotion and application.