合并组织缺损手掌贯通伤一期显微外科修复

目的探讨合并组织缺损的手掌贯通伤的损伤特点和显微外科修复的疗效。方法2001-06～2006-06对22例各种原因导致合并组织缺损的手掌贯通伤患者,急诊行清创一期显微外科修复:两侧皮肤缺损并掌骨干骨折或缺损者16例,行足背双叶皮瓣或第一跖背、跖底串联皮瓣移植修复皮肤缺损,取髂骨植骨修复骨缺损,同时取趾长伸肌腱修复肌腱缺损,取跖背神经修复神经缺损;两侧皮肤缺损并掌指关节缺损者6例,行携带跖背、跖底皮肤的跖趾关节移植,同时取趾长伸肌腱修复肌腱缺损,取跖背神经修复神经缺损。随访治疗效果并进行分析。结果本组22例,随访8～56个月,平均30个月。皮瓣全部成活,伤口一期愈合,移植骨全部愈合,手掌外观、感觉、运动功能恢复良好。结论对于合并组织缺损的手掌贯通伤,通过急诊清创并运用显微外科方法一期修复皮肤、骨、关节、肌腱、神经等各种组织的缺损,可以缩短病程,最大程度的恢复手掌的外观、感觉及功能,是一种高效、快捷的方法。

The injury characteristics and microsurgery repair method of palm penetrating wound complicated with tisue defect

Objective To explore the injury characteristics and microsurgery repair method of palm penetrating wound compliceted with tissue defect ＂after wound. Methods From June 2001 to June 2006,22 cases of palm penetrating wound complicated with tissue defect were subjected to emergency and microsurgery repairment there were 16 cases of both-side skin defect complicated with metacarpal fracture or defect,which skin defect was repaired by free bifoliate dorsal foot flap or dorsal-sole metatarsal series flap,bone defect by iliac bone, tendom and nerve defect with extensor digitorum and cutaneous nerve of dorsal foot;there were 6 cases of both-side skin defect complicated with metacarpophalangeal points defect, which were repaired by free metatarsophalangeal point carried with the skin of dorsal-sole metatarsal, tendom and nerve defect with extensor digitorum and cutaneous nerve of dorsal. foot. The cure effect was analysed after follow up. Results The 22 cases were followed up of 8-56m （averaged 30m）,all flaps surived,wound healed at stage one, bone grafted unioned, the outline and the sensory and the function of the palm were satisfied.Conclusion Emergency debridement and microsurgery repairment of skin and bone and tendom and nerve defect for palm penetrating, which wound is complicated with tissue defect could shorten the treatment course, mostly recover the outline and the sensory and the function of the palm mostly. It＇s a high efficient and rapid method.