经软组织扩张前臂逆行筋膜皮瓣的临床应用

为了避免以往的皮瓣，皮片方法修复手部外伤，烧伤晚期，先天性手畸形而造成的软组织缺损，我们采用经软组织扩张的前臂逆行筋皮瓣的新方法。１９８８年８月至１９９１年１月，３０例手，腕部软组织缺损的患者接受了治疗，除１例皮瓣远端部分坏死外，其余人武部成活，随访３个月效果满意。     

皮瓣转移修复四肢软组织缺损

皮瓣转移修复四肢软组织缺损谢德如，杜贵忠自１９８８年以来，应用前臂及足背部岛状皮瓣修复手拇指及足趾皮肤缺损，前臂、胸腹部任意带蒂皮瓣修复各部位皮肤软组织缺损４７例，均获得成功。经１～３年随访，效果满意。现报道如下。１临床资料本组４７例，男３５例，女１...     

桡神经浅支营养动脉岛状皮瓣在手外科的应用

创伤或爆炸伤所致手部皮肤软组织严重缺损修复比较困难。我们采用以桡神经浅支营养动脉为蒂的前臂逆行岛状皮瓣修复７例，随访６个月～１年，效果满意，报告如下：资料与方法１．一般资料：本组共７例，男６例，女１例，年龄１０～５３岁。皮瓣面积最大１２cm×１０cm，最小８cm×５cm。５例因爆炸伤致虎口皮肤软组织严重缺损，２例因冲床伤致手背软组织缺损，掌指关节、掌骨外露，伸肌腱缺损。采用以桡神经浅支营养动脉为蒂的逆行岛状皮瓣转移修复。结果术后皮瓣全部成活，经６个月～１年随访，手外形美观、功能、皮瓣感觉恢复良好。２．方…     

微型皮瓣修复手指皮肤软组织缺损

目的 探讨对不同类型的手指皮肤软组织缺损，选用不同类型的微型皮瓣游离修复的方式和效果。方法 根据损伤部位和特点，将手指皮肤软组织缺损分成9类，选用9种不同类型的微型皮瓣对170例手外伤进行游离移植修复。结果 术后皮瓣存活168例，坏死2例。术后随访2个月～3年，皮瓣质地、外形及功能均较满意，两点分辨觉为6～10mm。手功能恢复满意。结论 不同类型的手指皮肤软组织缺损应选用不同类型的微型皮瓣游离修复，皮瓣具有良好的血供，供区隐蔽，外形及功能恢复满意等优点，是修复手部皮肤软组织缺损较为理想的方法。     

岛状皮瓣移位修复手部软组织缺损

岛状皮瓣移位修复手部软组织缺损颜嘉麟＊张普国＊何炳根＊黄明光＊我院１９８４年１月～１９９４年１０月，应用手和前臂岛状皮瓣移位修复手及腕部软组织缺损９６例，取得较好效果。现报道如下。１临床资料本组男７０例，女２６例。急诊手术６８例，择期手术２８例。应用...     

游离下腹部皮动脉穿支皮瓣修复手背部缺损简

目的探讨游离下腹部皮动脉穿支皮瓣修复手背部软组织缺损的临床疗效。方法对8例手背部软组织缺损伴深部组织外露,应用游离下腹部皮动脉穿支皮瓣进行修复。皮瓣面积最小5cm×6cm,最大10cm×7cm。结果本组8例,1例皮瓣远端部分坏死,坏死组织清除植皮愈合,另7例成活。随访6个月～1年,外观及功能满意。结论应用游离下腹部皮动脉穿支皮瓣修复手背部软组织缺损,皮瓣质地良好、切取方便、设计灵活、供区隐蔽,是修复手背部软组织缺损的方法之一。     

游离下腹部皮动脉穿支皮瓣修复手背部缺损

目的探讨游离下腹部皮动脉穿支皮瓣修复手背部软组织缺损的临床疗效。方法对8例手背部软组织缺损伴深部组织外露,应用游离下腹部皮动脉穿支皮瓣进行修复。皮瓣面积最小5 cm×6 cm,最大10 cm×7 cm。结果本组8例,1例皮瓣远端部分坏死,坏死组织清除植皮愈合,另7例成活。随访6个月~1年,外观及功能满意。结论应用游离下腹部皮动脉穿支皮瓣修复手背部软组织缺损,皮瓣质地良好、切取方便、设计灵活、供区隐蔽,是修复手背部软组织缺损的方法之一。     

胸脐皮瓣转移修复软组织缺损

胸脐皮瓣转移修复软组织缺损王肃生１余楠生２白波２１９８８年～１９９５年，采用胸脐皮瓣转移分别修复手、臂、会阴、腹股沟软组织缺损１８例，均获满意效果。介绍如下。１临床资料本组１８例，男１５例，女３例。年龄１５～４６岁。急诊手术６例，择期手术１２例。烧伤...     

应用腹股沟带蒂皮瓣修复多指中节软组织缺损

目的探讨多指中节软组织缺损的手术治疗方法。方法总结29例应用腹股沟连蒂皮瓣修复多指中节软组织缺损的手术治疗方法和效果。结果29例皮瓣全部成活，3周后断蒂分指，一期剔薄皮瓣修复手指外形。随访3～18个月，除4例出现屈肌腱Ⅱ区粘连，3个月后行粘连松解术，手的抓捏握持功能和外观均恢复满意。结论腹股沟连蒂皮瓣是修复多指中节软组织缺损实用有效且可靠的方法，技术要求不高，适宜基层医院推广应用。     

选择性利用游离皮瓣修复手、腕部软组织缺损

目的探讨多种游离皮瓣精细修复手、腕部软组织缺损的临床效果。方法针对手腕部软组织的缺损面积及形状等特点,对比分析皮瓣部位的质地、纹理,选取与手腕部相近似的5种游离皮瓣进行精细修复187例。修复方式：足底内侧动脉穿支皮瓣修复手掌及大鱼肌处软组织缺损49例．小腿后侧皮瓣修复全手掌侧软组织缺损46例,小腿外侧皮瓣修复手背软组织缺损42例,足背皮瓣修复手背软组织缺损伴伸肌腱缺损42例,髂腹股沟皮瓣修复手腕部软组织缺损8例。结果本组187例中185例皮瓣顺利成活,2例皮瓣远端少量坏死,经植皮后愈合。随访187例,随访时间6个月～3年,皮瓣质地良好,无明显臃肿,两点辨别觉6～9mm,手部经功能康复训练后,优96例,良71例。可20例,功能恢复满意。结论根据创面缺损形状与大小,选择不同游离皮瓣修复手、腕部软组织缺损,能达到精细修复目的．大大地提高了手功能。     

Reversed island forearm fascial flap in hand surgery

We present a technique using a reversed island forearm fascial flap based on the distal portion of the radial artery and veins, with a skin graft on top, to repair a soft tissue defect of the hand. Good results were obtained in a total of 18 operations in 17 postburn cases. The operation can be completed in one stage even when it involves the excision of scar tissue, correction of the secondary deformities of deep structures, and repair of the soft tissue defect of the hand. The advantages and disadvantages of the method and key points of the technique are discussed.     

髂腹股沟皮瓣联合股部皮瓣带蒂瓦合移植在手部大面积套脱伤治疗中的应用

目的 介绍髂腹股沟皮瓣联合股部皮瓣带蒂移植治疗手部大面积套脱伤的手术方法和临床效果.方法 对7例手、腕及前臂部广泛皮肤套脱伤的患者,采用髂腹股沟皮瓣联合股前外侧皮瓣带蒂移植修复4例,联合阔筋膜张肌皮瓣带蒂移植2例,联合股前侧皮瓣带蒂移植1例.髂腹股沟部供区创面直接闭合,股部供区创面取全厚层皮片植皮覆盖.术后半个月拆线,并进行皮瓣夹蒂训练,术后1个月根据皮瓣夹蒂训练情况酌情断蒂.急诊一期修复2例,二期修复5例.结果 术后7例皮瓣全部存活,供区伤口I期愈合,随访2～6个月,皮瓣柔软,质地良好,皮瓣外形较臃肿,无坏死及破溃.结论 髂腹股沟皮瓣联合股部皮瓣带蒂移植,二者瓦合可覆盖全手及前臂大面积皮肤套脱伤,手术操作简单,安全性高,易于推广;该皮瓣缺点是需二期手术断蒂,且移植皮瓣外形臃肿,需后期整形.     

Posterior Interosseous Artery Flap for Resurfacing Posttraumatic Soft Tissue Defects of the Hand

The need for soft tissue coverage of large defects in the hand and the wrist following trauma is a common problem for hand surgeons. Flap coverage of these defects can be either in the form of distant or regional flaps. The posterior interosseous artery flap recently has emerged as a front runner in these situations by its virtue to preserve both the major arteries to the hand. Thirty-two posterior interosseous artery flaps were used in 32 patients with complex soft tissue defects of the hand. All these defects were posttraumatic. There were associated skeletal and soft tissue injuries in 20 patients. The donor site was closed either primarily or by a split skin graft depending on the size of the defect. All flaps healed well, and there were no incidences of flap necrosis. The donor site required a split skin graft in 24 patients. The flap was bulky in one patient and transient extensor carpi ulnaris weakness was seen in three patients. The posterior interosseous artery flap is a versatile flap for coverage of soft tissue defects of the hand. Good aesthetic results can be achieved with minimal donor site morbidity. Harvesting the flap requires a precise surgical technique and as many perforators as possible should be preserved to ensure flap viability.     

游离尺动脉腕上皮支下行支皮瓣的临床应用

目的 介绍游离尺动脉腕上皮支下行支皮瓣修复手部创面的手术效果。方法 对47例手部软组织缺损的患者，采用以尺动脉腕上皮支下行支为血管蒂的游离皮瓣进行修复。结果 术后46例皮瓣全部成活，1例皮瓣远端部分坏死．经植皮后愈合。术后随访6～18个月，皮瓣质地、外形满意，两点分辨觉为6～9mm。结论 应用尺动脉腕上皮支下行支皮瓣修复手部创面．血管解剖较恒定，操作简便，值得临床推广应用。     

足背串联皮瓣修复手部两处皮肤软组织缺损

目的 探讨应用游离足背串联皮瓣修复手部两处皮肤软组织缺损的临床效果.方法 2003年2月至2009年2月,采用游离足背串联皮瓣修复手部两处皮肤软组织缺损11例.其中手掌2处皮肤软组织缺损3例,手背2处皮肤软组织缺损4例,手背皮肤软组织缺损伴中指近节掌侧皮肤软组织缺损1例,手部洞穿伤致手背、手掌洞穿性皮肤软组织缺损3例,切取皮瓣面积:近端皮瓣3 cm×3 cm～8 cm×7 cm,远端皮瓣4 cm×2 cm～6 cm×5 cm.足部供区采用全厚皮片植皮.结果 术后所有皮瓣均一期成活,伤口甲级愈合,足部供区植皮均顺利成活.10例获随访6～19个月,平均随访9个月.随访皮瓣质地优良,外观自然、不臃肿,感觉恢复S2～S3,手部功能恢复满意,足部供区愈合良好,无破溃及溃疡形成,行走功能无影响.结论 应用足背串联皮瓣修复手部两处皮肤软组织缺损,具有皮瓣设计灵活、质地优良等优点,是修复手部两处皮肤软组织缺损的较好方法.     

An approach to curative effect of large autografts on adipose tissue in special parts with third-degree burns

Burns involving face, hand, dorsum of foot and areas around joints are regarded as burns of special parts. Because of the structural characteristics we emphasize the importance of preserving subeschar adipose tissue and using large sheets of skin graft in these parts of body during the resurfacing procedures. Thirty-one cases with 56 sites of deep burns were observed. The results were good. Followup in three typical cases is reported in detail in this article. Preserving subeschar healthy fatty tissue can ensure high graft take rate, early functional recovery, and immediate as well as long-range curative effect. So one must carefully judge the cutting depth of eschar excision. We prefer grafting debrided facial wounds with sheets of skin according to regional units. The minimal width of circular grafts around ankle and wrist is discussed. For wrist, the recommended minimal width is 4 cm; for ankle, it is 5 cm.     

负压吸引技术在手部挤压伤治疗中的应用

目的探讨负压吸引技术（Vacuum sealing drainage,VSD）在严重手部挤压伤创面治疗中的价值。方法选取12例手部挤压伤创面病例,清创,创面使用VSD1-2个疗程后,植皮修复创面。结果经VSD治疗后,创面肉芽生长迅速,肉芽平整密实,无感染,植皮均Ⅰ期成活。结论VSD可有效促进手部挤压伤创面的治疗进程。     

A totally laparoscopic peritoneal free flap for reconstruction of hand

Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm * 12 cm. The peritoneal flap measuring 22 cm * 15 cm survived completely without any complications. A following split-thickness skin graft offered the successful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue defects accompanied by exposed tendons on the hand and foot.