中西医结合治疗断指再植术后静脉危象

目的：观察中西医结合综合治疗对断指再植术后静脉危象的治疗效果。方法：切取邻指背侧带蒂皮瓣，转入患指指背区，切除栓塞静脉段及炎性水肿皮缘，皮瓣静脉与指背静脉吻合。术后应用复方丹参注射液和水蛭胶囊。结果：8例断指静脉危象全部纠正，指体功能及外形均满意，供指无明显功能障碍。结论：选用邻指皮瓣转移至患指，利用其静脉与患指远端静脉吻合，同时又可提供健康的皮肤覆盖，手术简便，效果好，实用性强。术后配合应用丹参液及水蛭，较好地解决了断指再植手术后静脉危象，提高了断指再植的成活率。     

指掌侧静脉在断指再植中的应用

目的研究吻合指掌侧静脉重建断指血运的方法。方法应用指掌侧静脉重建断指血运27例，其中行指掌侧静脉端端吻合20指，与指背静脉交叉吻合4指，指掌侧静脉动脉化3指。结果25指顺利成活，1例于术后24h发生静脉危象，另1例于术后8h发生血管危象，经二次手术探查，再植手指顺利成活。结论对于利用背静脉重建血运的断指，可行指掌侧静脉端端吻合、与指背侧静脉交叉吻合和远断端静脉动脉化等方式重建手指血运，以提高再植成功率。     

吻合血管邻指掌侧皮瓣修复断指皮肤与静脉缺损

目的为伴有指背皮肤和静脉缺损的断指再植提供一种新的修复方法. 方法切取邻指掌侧带蒂皮瓣,解剖指掌侧浅静脉远端,翻转皮瓣180°覆盖指背皮肤,皮瓣中浅静脉远近端分别与指背静脉吻合. 结果本组应用23例,皮瓣与再植手指全部成活,皮瓣色泽、弹性接近正常.结论邻指掌侧皮瓣移植在手指背侧皮肤和静脉缺损的断指再植中应用,具有手术简便,效果良好等优点.     

充分合理利用转移皮瓣修复手部软组织缺损

1　资料与方法本组共 45例 ,男 2 6例 ,女 19例 ,年龄 7～ 5 4岁。采用方法如下 :邻指随意皮瓣 10例 ,邻指筋膜瓣 6例 ;吻合指背神经的侧方逆行固有动脉指背神经蒂皮瓣 7例 ;吻合浅静脉的掌背侧支逆行岛状皮瓣 4例 ;吻合血管神经的第 1、2趾蹼间皮瓣 3例 ;带蒂食指近节背侧岛状皮瓣 9例 ;腹部S型超薄皮瓣 6例。结果 :1例吻合浅静脉的掌背动脉背侧支皮瓣及 1例食指背侧顺行岛皮瓣出现水泡 ,Ⅱ期愈合 ,其余皮瓣全部成活。随访 6个月～ 3年 ,皮瓣外观良好 ,感觉功能达S3级。2　讨　论手指部软组织缺损 ,如不涉及指腹 ,或者指神经未完全损伤 ,…     

微型静脉皮瓣桥接断指再植

我院１９９２年９月至１９９８年７月在作者单位：５１１７３８广东省东莞市桥头医院１０５例１７６指断指再植中应用游离微型静脉皮瓣移植或带血管蒂的微型静脉皮瓣转移移植，桥接吻合指背静脉、修复指背皮肤缺损共７例，均获成功。临床资料本组男６例，女１例，年龄１６...     

指掌侧静脉吻合在复杂性断指再植中的应用效果

目的探讨指掌侧静脉吻合在复杂性断指再植中的应用效果。方法对手指离断伤患者50例(60指)采用显微镜下清创后使用指掌侧静脉吻合法重建断指血液循环,观察患者伤指的成活率、临床状态和术后优良率。结果 60例断指中有55指(91.7%)手指断指再植成活,5指手指断指再植失活(8.33%)。再植手术手指成活55指中有4指在术后3 d内出现静脉危象现象,6指在术后3 d内出现动脉痉挛,经对症治疗后均得以改善。失活5指中有3指发生顽固性动脉痉挛,有2指出现静脉危象现象,经对症治疗后无好转,均行II期截指术。50例(60指)经断指再植评定标准评定后有40指(66.67%)为优,15指(25.00%)为良,5指(8.33%)为差,优良率为93.33%。结论在复杂性手指离断的断指再植术中,指掌侧静脉吻合法作为指背静脉的补充手段,能有效提高再植成活率和优良率。     

吻合浅静脉的邻指逆行指动脉Y-V血管蒂皮瓣的临床应用

目的 探讨吻合浅静脉的邻指逆行指动脉Y-V血管蒂皮瓣修复手指软组织缺损的方法及临床效果. 方法 2009年3月至2011年6月,利用吻合浅静脉的邻指逆行指动脉Y-V血管蒂皮瓣修复20例手指近指间关节以远软组织缺损,其中示指12例,中指8例,皮瓣面积最大4.5 cm×3.5 cm,最小3.5 cm ×2.5 cm,血管蒂长度平均4.0 cm,均吻合一支浅静脉,缝接指背神经14例,供区全厚皮片植皮.结果 20例皮瓣全部顺利成活,随访8 ～16个月,皮瓣外形及质地满意,缝接神经的两点辨别觉恢复至7～9 mm,未缝接神经的感觉恢复至S2～S3,供区外形及功能无明显影响. 结论 邻指逆行指动脉Y-V血管蒂皮瓣可形成较长的血管蒂,修复近指间关节以远软组织缺损,通过吻合浅静脉可明显减轻皮瓣的静脉回流压力,提高皮瓣的成活质量,术后疗效满意.     

邻指背侧静脉蒂岛状皮瓣在断指再植中的应用

背侧皮肤及血管同时缺损的断指,用常规方法难以完成再植。1994年以来,我们用邻指背侧静脉蒂岛状皮瓣移位,将皮瓣中的指背静脉与断指远端的指背静脉吻合,同时修复皮肤缺损及重建断指静脉回流通路,为组织缺损的复杂性断指再植提供了一种新方法。 1 临床资料 本组6例,男5例,女1例。年龄18～35岁。致伤原因:挤压伤4例,铡刀伤2例。完全性离断4例,不完全性离断2例。     

静脉动脉化筋膜蒂岛状皮瓣修复手指末节皮肤软组织缺损42例疗效观察

目的观察静脉动脉化筋膜蒂岛状皮瓣修复手指末节皮肤软组织缺损的疗效。方法选取2016-04—2018-03间手指末节皮肤软组织缺损的42例患者,均采用静脉动脉化筋膜蒂岛状皮瓣修复术。治疗后随访1 a,统计皮瓣切取部位、面积、成活及术后恢复情况。结果 42例患者中7例为指背神经营养血管皮瓣,15例为指桡背侧筋膜蒂皮瓣,8例为掌背筋膜蒂皮瓣,12例为指尺背侧筋膜蒂皮瓣。皮瓣切取面积1.92 cm×1.53 cm～6.17 cm×4.75 cm。术后4～6 d,皮瓣呈淡红色,肿胀明显。其中5例皮瓣边缘甚至出现水疱,水疱于拆除蒂部缝线4～6 d后消失、术后10 d左右肿胀亦随之消退,逐渐出现皮瓣皮纹,可见皱褶,呈红润状态。术后42例患者皮瓣均存活,手指恢复优23例、良9例、可7例、差3例。结论静脉动脉化筋膜蒂岛状皮瓣修复手指末节皮肤软组织缺损,皮瓣成活率高、手部功能恢复好。     

带指背神经筋膜蒂顺行岛状皮瓣的临床应用

目的 探讨带指背神经筋膜蒂顺行岛状皮瓣一期修复邻指软组织缺损的方法。方法 2001年10月-2006年5月，对38例手指近、中节的掌、背侧皮肤缺损的患者，采用邻指带指背神经筋膜蒂顺行岛状皮瓣转移修复。结果 38例皮瓣全部存活，术后随访5个月～1年，手指功能及外观良好，伤指无疼痛，皮瓣质地柔软，弹性好，两点分辨觉为8～10mm。结论 该术式操作简单，疗程短，疗效满意，是治疗手指皮肤缺损可行的一种手术方法。     

游离静脉皮瓣修复断指伴皮肤和指动脉缺损的疗效分析

目的评价应用前臂或足背静脉皮瓣修复断指伴皮肤和指动脉缺损的疗效。方法对13例断指伴掌侧皮肤、动脉缺损的患者行前臂静脉皮瓣移植8例,足背浅静脉皮瓣移植5例,其中带肌腱重建屈指功能3例,均为一期修复。结果13例静脉皮瓣与再植手指全部成活,外形与功能良好。结论静脉皮瓣一期修复再植手指血管与皮肤缺损操作方法可行,对供区损伤小,成活率高,手指外形好,如伴肌腱缺损．可同时重建手指屈伸功能。     

Der Crossfingerlappen

OBJECTIVE: Soft-tissue coverage by tissue transposition from a neighboring finger of a palmar (classic cross-finger flap) or dorsal (reversed cross-finger flap) soft-tissue defect of the phalanges. INDICATIONS: Conventional cross-finger flap: soft-tissue defects in the proximal or middle phalanges not suitable for skin transplantation. Reversed cross-finger flap: soft-tissue defects in the dorsal proximal or middle phalanges not suitable for skin transplantation. CONTRAINDICATIONS: Extensive tissue defects crossing the finger joints. Concomitant injuries of the neighboring fingers. SURGICAL TECHNIQUE: Harvesting of an adipocutaneous flap from the dorsum of the finger to the midlateral line, preserving the paratenon of the donor phalanx. Transfer of the flap into the defect of the neighboring finger and coverage of the donor site by full-thickness skin grafting. For the reversed cross-finger flap preparation of a subcutaneous flap with preservation of the peritenon by separating a skin flap from the subcutaneous fat according to the "open book - closed book" technique. Transection of the flap pedicle after 14-21 days. POSTOPERATIVE MANAGEMENT: Immobilization of both fingers until the pedicle is transected. Active and passive physiotherapy exercises after 5-7 days. RESULTS: Uneventful healing in all 18 cross-finger flaps, resulting in an average DASH Score (Disability of the Arm, Shoulder and Hand) of 18 after an average follow-up of 38 months (12-81 months). Twelve results were subjectively judged as "very good" or "good", 16 patients complained about intermittent cold intolerance.     

A novel solution for venous congestion following digital replantation: a proximally based cross-finger flap

Digital replantations are often complicated by problems of venous congestion. Conservative management is not always successful. Furthermore, the skin edge around the replanted digit is frequently inflamed and necrotic, leading to difficulties in restoring venous flow by direct venous anastomosis or interpositional vein grafts. We introduce a novel solution using the proximally based cross-finger flap. We used this flap in 10 patients who had venous congestion with inflamed, necrotic skin at their digital replant site. Their initial injuries were amputation injuries. The flap had an average length of 3.98 cm and width of 2.59 cm and was harvested from the dorsum of the adjacent, uninjured digit. There was only 1 failure, due to massive crush injury. Of the remaining 9 cases, 7 met or exceeded the sensory threshold (Semmes-Weinstein monofilament test). The 2-point discrimination test was less than 6 mm in 8 cases. Three patients complained of residual pain (based on the Michigan Hand Outcomes Questionnaire), and only 1 was unsatisfied with the appearance. The proximally based cross-finger flap is pedicled and requires only a single level of venous anastomosis distally, leading to a higher success rate. It offers a simple yet effective solution for venous congestion.     

Cross-finger flaps from scarred skin in burned hands

An innovation is described in the secondary repair of two types of longstanding post-burn flexion contracture of the little finger. The correction of the PIP joint flexion contractures caused by palmar burns can result in a defect on the palmar side of the finger after incision or excision of the scar. The reconstruction of the post-burn buttonhole flexion deformity of the PIP joint, can result in a defect on the extensor surface of the PIP joint after excision of the dorsal scarred skin. Both acquired defects were covered by two different cross-finger flap techniques, despite extensive scarring of the adjacent finger. It is evident that mature post-burn scarred skin on the dorsum of the finger can be utilised for a cross-finger flap procedure.     

指背筋膜蒂岛状皮瓣修复同指指腹皮肤软组织缺损

目的 探讨一种新的筋膜蒂岛状皮瓣修复指腹皮肤软组织缺损的有效方法。方法 于指背形成筋膜蒂岛状皮瓣并移转至指腹创面。结果 临床已应用6例，皮瓣全部成活。结论 指背筋膜蒂岛状皮瓣可以安全、简便地修复同指指腹的创面。     

双干型静脉皮瓣在撕脱性断指再植中的应用

目的 报告双干型静脉皮瓣在撕脱性断指再植中的应用和临床效果.方法 2007年3月至2009年6月,采用前臂双干型静脉皮瓣游离移植修复伴有皮肤软组织缺损的撕脱性断指6例,损伤至入院时间为30 min至8 h,切取皮瓣面积为1.8cm×1.8cm～2.2 cm×5.8cm,供区创面直接缝合.结果 术后6例伤口均Ⅰ期愈合,断指再植全部存活;5例静脉皮瓣无肿胀,顺利存活;1例皮瓣早期肿胀明显,紫红色,并见散在小水泡,经拆除部分缝线、换药等对症处理后顺利存活.术后随访时间为6个月至2年.皮瓣及再植手指血运好,皮瓣质地软,弹性好、耐磨.根据中华医学会手外科学会断指再植功能评定试用标准评定;优4例,良1例,可1例;优良率为82.5%.结论 采用前臂掌侧双干型静脉皮瓣游离移植修复伴有皮肤软组织缺损的撕脱性断指,能最大程度地恢复手指的功能和外形.

Abstract：

Objective To report the application and results of venous flap with double vein trunks in replantation of degloved fingers.Methods From March 2007 to June 2009, 6 cases of soft tissue defect in the degloved finger were replanted with venous flap with double vein trunks.The interval between injury and operation was 30 minutes to 8 hours.All fingers were replanted by arterialized free venous flap from the ipsilateral forearm with double vein trunks.The flap was 1.8 cm×1.8 cm to 2.2 cm× 5.8 cm in size.The donor site was directly closed.Results Primary wound healing was observed in all 6 cases postoperatively.All the replanted fingers survived completely.In 5 cases the venous flaps survived uneventfully.In 1 case there was partial superficial necrosis of the flap which healed with conservative management.Postoperative follow-up ranged from 6 to 24 months.The flaps and fingers had good circulation, good texture and color match.According to the criteria for functional assessment of amputated finger issued by the Chinese Hand Surgery Society, the results were graded as excellent in4cases, goodin 1 case, andfairin 1 case.Theoverall excellent rate was 82.5%.Conclusion Replantation of degloved finger with fransfer of venous flap with double vein trunks is capable of repairing pulp soft tissue defect and maximizing the restoration of finger appearance and function.     

Innervated reverse dorsal digital island flap for fingertip reconstruction

PURPOSE: Various methods of fingertip reconstruction with a sensory flap have been reported. Digital island flaps or cross-finger flaps have to be used for large defects; however, the digital artery is sacrificed when creating conventional homodigital island flaps and 2 surgeries are required for the cross-finger flap. We describe our experience with an innervated reverse dorsal digital island flap that does not require sacrifice of the digital artery. METHODS: We used innervated reverse dorsal digital flaps for fingertip reconstruction in 8 patients. The flap was supplied by the vascular network between the dorsal digital artery (the terminal branch of the dorsal metacarpal artery) and the dorsal branch of the digital artery. Venous drainage was through the cutaneous veins and the venous network associated with the dorsal arterial network. The flap was designed on either the dorsal proximal or the dorsal middle phalangeal region. The flap was harvested with the dorsal branch of the digital nerve (for the dorsal middle phalanx), the dorsal digital nerve (for the dorsal proximal phalanx), or the superficial branch of the radial nerve (for the thumb), which was anastomosed to the distal end of the digital nerve. After flap transfer the donor site was covered with a full-thickness skin graft. RESULTS: Of the 8 flaps, 6 survived completely, 1 had partial epithelial skin necrosis, and 1 showed central compression skin necrosis. Three flaps showed congestive changes from the first to the fifth day after surgery, which resolved by massage. All patients achieved satisfactory recovery of sensation; the static 2-point discrimination ranged from 3 mm to 5 mm and the Semmes-Weinstein test results ranged from 0.036 g to 0.745 g. CONCLUSIONS: The innervated reverse dorsal digital island flap provides another option for homodigital tip coverage. The advantages are that the digital artery is not sacrificed and only 1 surgery is needed. A disadvantage is the potential for venous congestion for the first 4 or 5 days after surgery.     

Der deepithelialisierte Cross-finger-Lappen

BACKGROUND: Injuries to the dorsum of the finger are common. Combination with exposure of important deeper structures needs reconstruction with a flap. The deepithelialized cross-finger flap is a good possibility for covering large dorsal finger defects. PATIENTS AND METHODS: From March 2003 to October 2003 six patients (two female, four male) underwent this procedure. RESULTS: Neither flap loss nor infection was observed. All defects were covered adequately, and no donor site problems occurred. One week after flap division, the function of the involved finger joints had the same range of motion as the contralateral finger joints. CONCLUSION: The deepithelialized cross-finger flap is a good and safe method for defect cover in large dorsal finger defects. The good postoperative range of motion supports the indication for this two-step reconstruction procedure.     

腕前区游离静脉皮瓣修复断指血管与皮肤缺损

目的总结游离静脉皮瓣在伴有血管及皮肤缺损的断指再植中的应用效果。方法临床应用18指,其中伴掌侧皮肤缺损15指,背侧皮肤缺损3指,从腕前区切取适宜大小的、带有皮下静脉和掌长肌腱的游离皮瓣植于手指组织缺损处,掌侧部位皮瓣倒置,背侧则同方向放置。结果除1例中指中节离断伴背侧血管和皮肤缺损于术后第3 d坏死外;17例术后手指均成活,外观及功能良好,功能评价:优11指,良4指,可2指。结论应用腕前区游离静脉皮瓣修复断指血管与皮肤缺损,效果良好,且简单易行。     

Technical modifications and extended applications of the distally based adipofascial flap for dorsal digital defects

A series of 15 cases of distally based adipofascial flaps to cover dorsal digital defects is presented. All flaps were raised just superficial to the dorsal veins (and hence preserving some fat with the reflected flaps) rather than raising them at the subdermal plane. In 3 cases where there was another injury proximal to the defect, which precluded the use of an adipofascial turnover flap from the injured digit, a distally based cross-finger adipofascial flap was used from the adjacent finger. In 4 cases, the flap was used to cover compound fractures. The results showed complete survival of all flaps without loss of the overlying skin graft and without epidermolysis of the donor skin, indicating that raising the flap just superficial to the dorsal veins does not affect the reliability of its blood supply, and yet it enhances the blood supply of the reflected skin flaps. The series also showed uneventful healing of compound fractures covered by the flap, indicating flap reliability to cover exposed fractures. Finally, the study demonstrated the feasibility of using the flap as a cross-finger flap.