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目的:探讨游离趾腓侧皮瓣与腓动脉穿支皮瓣修复手部皮肤软组织缺损的设计切取方法及临床疗效。方法2009年2月—2013年1月,对46例手部不同部位、形态的皮肤软组织缺损,分别采用游离趾腓侧皮瓣修复25例,游离腓动脉穿支皮瓣修复21例,皮肤缺损范围为1.5 cm×2.5 cm~3.0 cm×6.5 cm,根据受区皮肤软组织缺损大小、形状设计和切取皮瓣。结果本组46例皮瓣全部成活,1例出现静脉危象,经小切口放血后危象解除,皮瓣成活。术后随访6~12个月,手部整体外观、功能恢复良好,皮瓣感觉部分恢复,供区无并发症。结论应用游离趾腓侧皮瓣或腓动脉穿支皮瓣修复手部皮肤软组织缺损,可恢复手部良好的外观与功能。趾腓侧皮瓣皮肤质地、外观更接近正常手部掌侧皮肤;腓动脉穿支皮瓣可根据手部创面大小灵活切取,二者均可作为理想的游离皮瓣修复手部皮肤软组织缺损。 相似文献
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游离腹壁浅动脉筋膜穿支皮瓣修复手部创面 总被引:3,自引:0,他引:3
目的 报告应用游离腹壁浅动脉筋膜穿支皮瓣修复手部创面的临床效果.方法 对10例手部皮肤软组织缺损的患者,采用游离腹壁浅动脉筋膜穿支皮瓣进行修复,皮瓣切取面积为8cm×6cm~16cm×9cm.结果 术后1例皮瓣发生血管危象,经探查后存活,其余皮瓣全部顺利存活.经4~12个月的随访,皮瓣质地、外形优良,手功能恢复满意.术后供区伤口均Ⅰ期愈合,外形满意.结论 应用游离腹壁浅动脉筋膜穿支皮瓣可以一期修复创面,供区损伤小,是修复手部创面的理想选择. 相似文献
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应用踝前与足背联合皮瓣游离移植修复手掌部贯通伤皮肤缺损 总被引:1,自引:1,他引:0
目的 探讨应用踝前与足背联合皮瓣游离移植修复手掌部贯通伤皮肤缺损的临床效果.方法 从2004年5月至2009年7月,应用踝前与足背联合皮瓣游离移植修复手掌部贯通伤皮肤缺损16例,两皮瓣由足背动、静脉相连,踝前皮瓣切取范围:3.5 cm×2.0 cm~7.0 cm×5.5 cm;足背皮瓣切取范围:5.0 cm×3.5 cm~8.5 cm×6.0 cm.结果 16例32块皮瓣全部成活,术后随访6个月~2年,根据2000年中华医学会手外科分会手功能评定试用标准综合评价:优8例,良5例,可2例,差1例,优良率为81.25%.结论 踝前与足背皮瓣血管解剖恒定,手术切取比较简便,一次手术可以完成手掌和手背两侧皮肤缺损的修复,应用踝前与足背联合皮瓣游离移植修复手部贯通伤可以获得较好的临床效果. 相似文献
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目的探讨一种较好的修复面部皮肤软组织缺损的手术方法。方法手术分两期进行。一期手术时,以颞浅动静脉为蒂,掀起颞顶浅筋膜岛状瓣,沿同侧发际线切开,在耳后乳突区皮下剥离,形成适当大小的囊腔,将颞顶筋膜瓣转移至囊腔内,适当固定,于筋膜瓣下放置皮肤扩张器;扩张完毕后,取出扩张器,以颞浅动静脉为蒂,掀起耳后乳突区预制岛状筋膜皮瓣,用于面部皮肤缺损的修复。结果自1999年以来,临床应用9例,其中面部黑痣2例,面部血管瘤2例,面部瘢痕5例。颞顶筋膜岛状皮瓣蒂长5.5~7cm,平均6.2cm,筋膜瓣面积4cm×3cm~7cm×7cm,平均5.7cm×4.9cm,预制筋膜皮瓣面积为5cm×5cm~8.0cm×7.5cm,平均6.4cm×6.1cm;术后皮瓣全部成活,供瓣区直接拉拢缝合者5例,另行皮片移植修复者4例。结论颞顶筋膜皮瓣血管蒂长,转移方便,血运丰富,耳后乳突区皮肤在质地、色泽、厚度等方面均与面部皮肤最为接近,是一种良好的修复面部皮肤软组织缺损的方法。 相似文献
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目的 介绍足部一蒂多瓣同时修复手部多处皮肤缺损的临床效果.方法 对8例19处手部创面采用一蒂多瓣的方法进行修复,其中以第一跖底动脉为蒂的第一、二趾侧方皮瓣修复5例12处;以足背动脉为蒂的跗外侧皮瓣及第一、二趾侧方皮瓣修复1例3处;以足背动脉为蒂的足背皮瓣及(足母)趾趾腹皮瓣修复2例4处.结果 术后8例19块皮瓣全部存活,随访时间为3~ 36个月,皮瓣外形逼真,两点分辨觉为5~11 mm,有排汗功能,术后供区植皮创面Ⅰ期愈合.结论 足部一蒂多瓣是同时修复手部多个创面的理想方法,它简化了手术步骤,缩短了手术时间,但应根据损伤类型、面积选择最合适的皮瓣. 相似文献
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Bilateral temporoparietal fascial free flaps were used for reconstruction of bilateral hand defects in two male patients. A 42‐year‐old man sustained crushed injury to both hands with avulsion defects and exposed bones and tendons. The two separate procedures were performed under general anesthesia. The temporoparietal fascial free flap was skin grafted on the ward on the following day after the operation. The other patient was a 61‐year‐old leprosy patient who had bilateral high ulnar nerve palsy for 28 years. One simultaneous procedure was performed under local anesthesia for harvesting the temporoparietal fascial free flaps and under brachial block for preparation of the recipient sites. The free flaps were used for augmentation of the atrophic first web spaces. The postoperative results of the two cases were satisfactory. The functions of both hands were restored with normal gliding mechanism of the tendons in the first case, and permanent correction of the atrophic web spaces was demonstrated in the second case. The temporoparietal fascial free flap is an ideal flap for coverage of hand defects as well as augmentation of first web space atrophy. © 2009 Wiley‐Liss, Inc. Microsurgery 2009. 相似文献
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掌、指背皮神经营养血管逆行岛状皮瓣修复手指皮肤缺损 总被引:3,自引:2,他引:1
目的 分析应用掌、指背皮神经营养血管蒂逆行岛状皮瓣修复手指皮肤缺损的疗效.方法 应用掌背皮神经营养血管蒂逆行岛状皮瓣18例(18块),带指神经背侧支的指背逆行岛状皮瓣15例(17块),修复手指皮肤缺损.观察皮瓣的成活率、质地、色泽和感觉.结果 术后皮瓣发生肿胀2例,静脉危象2例.33例35块皮瓣全部存活.术后随访时间为3~18个月,平均12个月.皮瓣外观、质地、弹性良好,有部分浅感觉恢复.结论 掌、指背皮神经营养血管蒂逆行岛状皮瓣不损伤主要血管、神经,操作简单,是修复手指创面的理想方法. 相似文献
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目的 应用皮神经营养血管蒂逆行岛状皮瓣修复手和足踝部的软组织缺损。方法 以前臂外侧皮神经、桡神经浅支和腓肠神经为轴线 ,分别根据手或足踝部受区大小、部位及供、受区距离设计出逆行岛状皮瓣。结果 腓肠神经营养血管皮瓣修复足踝部创面 4例 ,前臂外侧皮神经营养血管皮瓣修复虎口部创面 1例 ,桡神经浅支营养血管皮瓣修复拇指软组织撕脱伤 1例 ,皮瓣全部成活。结论 根据皮神经营养血管与皮肤血管相互交通的关系设计出的皮神经营养血管皮瓣 ,为手和足踝部软组织缺损的修复提供了血供可靠、简便快捷的新方法 相似文献
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目的探讨利用三种游离皮瓣及带前臂皮神经营养血管岛状皮瓣修复手背软组织缺损的临床效果。方法采用小腿外侧皮支皮瓣、足背皮瓣、股前外侧皮瓣及带前臂内、外、背侧皮神经营养血管岛状皮瓣,选择性修复手背软组织缺损225例。结果本组174例三种游离皮瓣中170例成活.4例出现血管危象,经及时探查1例皮瓣全部坏死,3例部分坏死:51例前臂皮神经皮瓣.除6例远端部分坏死外,余全部成活。随访6个月~8年.皮瓣质地好,色泽正常,手外形与功能改善满意,痛、深触觉逐渐恢复正常。结论选择性游离皮瓣修复效果普遍优于前臂皮神经营养血管的岛状皮瓣,适于临床开展。 相似文献
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目的 探讨上臂远端外侧肱骨骨皮瓣在手外科的临床应用效果.方法 对8例手部复合组织缺损的患者,根据掌指骨缺损的情况,先设计骨瓣的切取位置和大小(骨瓣远端止于肱骨外上髁的上缘),然后再根据皮肤缺损的面积和骨缺损的相对位置设计皮瓣的大小.前臂后皮神经位于皮瓣的中轴线上,可以保留或一并切取使用,恢复受区感觉.皮瓣切取面积为4.0cm×8.0cm~6.0cm×8.0cm,骨瓣切取大小为4.0cm×1.5cm×1.0cm~6.0cm×1.5cm×1.0cm.结果 术后8例骨皮瓣全部存活,上臂供区创面直接闭合,愈合好,上臂功能无影响.术后随访4~24个月,皮瓣感觉恢复良好,移植骨完全愈合,手部外形满意.结论 上臂远端外侧肱骨骨皮瓣是修复手部创面和掌、指骨复合组织缺损的理想选择. 相似文献
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The ideal reconstructive method for the palatal defect should provide durable, stable coverage, and a natural contour, while simultaneously minimizing morbidity of both the defect and donor sites. Although small and usual palatal defects can be repaired easily using local adjacent tissues, successful closure of large, complex defects is still a challenging problem. Numerous free tissue options have to date been described for large palatal defects. Although the radial forearm flap constitutes a good option for ideal reconstructive goals, the sacrifice of a major artery to the hand and the skin graft to the forearm with its high potential risk of complications are evident problems attendant upon this donor site. Since the first report of the anterolateral thigh flap, this has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Between April 2005 and May 2009, 8 free anterolateral thigh flaps were used to reconstruct defects of the palate. The study involved 6 male and 2 female patients, their ages ranging from 3 to 45. Five patients had palatal defects due to congenital cleft palate deformity, 2 patients had defects due to tumor resection, and the remaining patient had a palatal defect due to a gunshot wound. The size of the flaps ranged from 8 to 14 cm in length and from 4 to 7 cm in width. Facial vessels were used as recipient vascular sources in all patients. Primary thinning of the flap was performed in all cases. Donor sites were closed directly and healed uneventfully in all patients. There were no postoperative complications and all flaps survived totally. No debulking was needed. All patients, and their families in the case of child patients, were satisfied with the results of their surgical treatment. In conclusion, although it has some irregularity in derivation from the main vessels, with its evident structural and cosmetic advantages the anterolateral thigh flap can be considered an excellent and ideal free flap option for most large palatal defects that cannot be closed by regional tissue in selected patients. It can reconstruct defects in single stage with well-vascularized tissue, resulting in minimal donor site morbidity. 相似文献
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游离足背皮瓣修复手背皮肤软组织缺损 总被引:1,自引:1,他引:0
目的 探讨游离足背皮瓣修复手背皮肤软组织缺损的临床效果.方法 对10例手背软组织缺损的患者,切取带腓浅神经的游离足背皮瓣移植修复,其中1例携带第3、4趾趾长伸肌腱,1例同时切取第二足趾再造中指.皮瓣切取面积为5 cm×4 cm~21 cm x 12 cm.结果 10例皮瓣全部存活,术后1例皮瓣发生血管危象,经手术探查发现静脉血栓形成,重新吻合血管后皮瓣存活.术后随访6~24个月,其中9例皮瓣无臃肿,皮肤质地、色泽接近正常皮肤,痛、温、触觉部分恢复;1例皮瓣肤色较深,质地硬.3例供区植皮坏死、肌腱外露,其中1例经换药后瘢痕愈合,1例行小腿内侧筋膜皮瓣修复,1例行足内侧岛状皮瓣修复.结论 应用足背皮瓣复合组织修复手背皮肤、肌腱和神经的缺损,是一种较理想的方法. 相似文献
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Gavaskar AS 《Hand (New York, N.Y.)》2010,5(4):397-402
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. 相似文献
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目的 探讨旋股外侧动脉降支多叶瓣修复手部多部位软组织缺损的手术方法和临床效果。方法对手部多部位软组织缺损15例,采用旋股外侧动脉降支多叶瓣修复,根据手部缺损情况设计股前外侧皮瓣,沿皮瓣穿支血管向远端继续解剖旋股外侧动脉降支,考虑好手部各缺损处间距,按需切取分叶穿支皮瓣、阔筋膜瓣、股直肌肌瓣、股外侧肌肌瓣、股中间肌肌瓣或旋股外侧动脉降支远端肌间隔瓣。形成以旋股外侧动脉降支为主干的一蒂多叶瓣,在肌瓣及阔筋膜瓣上植皮,一次修复手部多部位软组织缺损。 结果 术后无血管危象发生。修复各创面在肌瓣、阔筋膜瓣或旋股外侧动脉降支远端血管肌间隔上植皮均成活良好,外形无臃肿,植皮处恢复保护性感觉,供区创面愈合好,股四头肌肌力及膝关节屈、伸活动均正常。全部病例获得随访,随访时间6 ~ 20个月,平均8.7个月。按中华医学会手外科学会上肢部分功能评定标准:优3例,良9例,可3例,优良率80%。 结论 旋股外侧动脉降支多叶瓣能一次修复手部多部位软组织缺损,缩短手术时间及疗程,手部功能恢复良好,外形满意,是修复手部多部位软组织缺损的理想方法。 相似文献