穿支皮瓣与腹部带蒂皮瓣治疗手外伤皮肤软组织缺损疗效比较

目的 通过比较手外伤皮肤软组织缺损患者接受穿支皮瓣与腹部带蒂皮瓣治疗的临床效果,探讨2种治疗方案的优缺点及适应证。 方法 选择武冈市人民医院2017年6月—2019年6月收治的42例手外伤皮肤软组织缺损患者作为研究对象。根据选用皮瓣不同分为2组:A组(21例)接受腹部带蒂皮瓣,B组(21例)接受穿支皮瓣,比较2组创面愈合时间、术后并发症发生情况以及患肢功能恢复情况。 结果 所有患者均获得随访,随访时间3~16个月,平均6.8个月。B组的皮瓣修复优良率为100.0%,显著高于A组的66.7%(χ2=6.171,P=0.013),B组愈合时间为(18.4±1.2)d,较A组的(35.9±1.4)d显著缩短(t=42.895,P<0.001)。B组术后发生感染、皮肤坏死等并发症的发生率为4.8%,显著低于A组的52.4%(χ2=11.667,P<0.001)。采用中华医学会手外科学会上肢部分功能评定标准评价术后效果,A组功能恢复及格率为66.7%,B组功能恢复及格率为95.2%,差异有统计学意义(χ2=5.559,P=0.018)。 结论 相比腹部带蒂皮瓣,穿支皮瓣对手外伤皮肤软组织缺损修复效果更加理想,且愈合时间较短、并发症较少,值得推荐。但对于基层医院尚未开展显微外科技术的情况下,腹部带蒂皮瓣不失为治疗手部皮肤软组织缺损的替代选择。 

Comparison of perforator flap and abdominal pedicled flap in the treatm ent of skin and soft tissue defect by hand traum a

Objective To investigate the clinical effect of perforator flap and abdominal pedicled flap in patients with skin and soft tissue defect resulting from hand trauma, and to explore the advantages, disadvantages and indications of the two treatment. Methods There were 42 patients suffering from skin and soft tissue defects by hand trauma from June 2017 to June 2019 in People's Hospital of Wugang. The patients were divided into two groups according to the selection of different flaps, group A(abdominal pedicled flap, n=21) and group B(perforator flap, n=21). The wound healing time, postoperative complications and functional recovery were compared between the two groups. Results All patients were followed up for 3 to 16 months, with an average of 6.8 months. The excellent and good rate in the group B(100.0%) was significantly higher than that in the group A(66.7%, χ2=6.171, P=0.013). The healing time in the group B(18.4±1.2) days was significantly shorter than that in the group A(35.9±1.4) days(t=42.895, P<0.001). The incidence of postoperative complications such as infection and flap necrosis in the group B was 4.8%, which was significantly lower than that in the group A(52.4%, χ2=11.667, P<0.001). The postoperative function was evaluated by the evaluation standard of upper limb function of hand surgery Association of Chinese Medical Association. The passing rate of functional recovery in the group A was 66.7%, and that in the group B was 95.2%(χ2=5.559, P=0.018). Conclusion Compared with the abdominal pedicled flap, perforator flap is more effective in repairing skin and soft tissue defects in hand followed by the shorter healing time and less complications, which is worthy of recommendation. However, abdominal pedicled flap can be regarded as an alternative when microsurgical technique has not been developed in some primary hospitals.