前臂骨间背串联皮瓣重建重度虎口及腕部挛缩畸形

目的总结前臂骨间背串联皮瓣重建重度虎口及腕部挛缩畸形的疗效。方法 2005年11月-2010年2月,收治26例虎口及腕部瘢痕挛缩患者。男18例,女8例;年龄12～45岁,平均27岁。致伤原因:热水烫伤7例,爆炸伤5例,交通事故伤3例,热压伤5例,火焰烧伤6例。左手11例,右手15例。发生瘢痕挛缩6～26个月,平均11个月。按顾玉东等的评定标准,均为重度虎口挛缩畸形;伴拇指内收畸形,拇指外展及对掌功能受限,腕掌关节屈曲畸形。行虎口及腕部瘢痕挛缩彻底松解后,缺损范围为5.8 cm×4.5 cm～11.3 cm×7.2 cm。采用大小为6.5 cm×5.0 cm～12.5 cm×8.0 cm的前臂骨间背串联皮瓣移位修复。供区直接缝合或游离植皮修复。结果术后2例皮瓣远端出现水疱,表皮坏死,经换药后皮瓣成活;其余皮瓣均顺利成活,创面均Ⅰ期愈合。供区植皮均成活,切口Ⅰ期愈合。26例术后均获随访,随访时间6～24个月,平均15个月。术后拇指内收、对掌及对指功能均有不同程度恢复。术后6个月,根据Swanson等拇指总活动度(AMA)系统评定拇指功能损害较术前显著降低,按Jensen等方法测量虎口角度及宽度均较术前显著增加,比较差异均有统计学意义(P<0.05)。结论采用前臂骨间背串联皮瓣重建重度虎口及腕部挛缩畸形可有效开大虎口,改善手腕功能。

Reconstruction of severe contracture of the first web space and wrist by incorporating pedicled retrograde flap of forearm transplantation

Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist.Methods Between November 2005 and February 2010,26 patients with severe contracture of the first web and wrist were treated.There were 18 males and 8 females with an average age of 27 years(range,12-45 years).The locations were the right sides in 15 cases and the left sides in 11 cases.The injury reason included hot w...