游离复合皮瓣一期修复腕晚期电烧伤畸形

目的 探讨应用游离复合皮瓣移植，在一次手术中完成多种组织缺损的修复，以提高晚期腕电烧伤的治疗效果。方法 设计以胫后动、静脉为滋养血管的皮瓣，保留其到跖肌腱的筋膜分支切取跖肌腱；通过小腿筋膜携带腓肠神经，从而达到带血供移植肌腱、神经、筋膜和皮肤的目的。同时，从足背切取趾长伸肌腱，将3～4条肌腱分别植人皮瓣深筋膜浅面，将复合皮瓣行吻合血管的游离移植到受区，用以一期修复受区的肌腱、神经、血管的长段缺损。术后定期随访，并对治疗效果进行评价。结果 本组5例，皮瓣移植均成活，随访3～12个月。其中3例在术后3～6个月达到屈指主动屈距掌纹4～5cm，伸指伸距水平3～4cm。2例术后6个月屈指主动屈距掌纹6cm，伸指伸距水平5cm，经补充手术，松解肌腱及功能锻炼，屈指主动屈距掌纹4cm，伸指伸距水平4cm。指腹感觉6个月时均达到S2级，患手皮温明显提高。结论 小腿内后侧胫动、静脉蒂游离复合皮瓣移植，可一次手术修复腕电烧伤后皮肤、肌腱、神经、血管等多种组织缺损，减少了手术次数，治疗效果良好。

Restore hand''''s function after electric injuries at the wrist by a free composite flap

OBJECTIVE: To introduce a new free composite flap for the treatment of electric injuries of hands, which can repair the skin, blood vessels, tendons and nerves injuries in just one operation. It may improve the prognosis of electric hand injuries. METHODS: 5 patients with electric injuries at wrist were treated by the free composite flap. The procedure is followed: The composite flap was harvested from medial lateral crural skin flap. Its blood supply was from tibial posterior vessels. The perforans arteries to flap and the branches to plantaris were preserved, and the nerve suralis and tendon plantaris were compound into the flap by carefully dissection of crural fascia. At the same time, 3-4 tendons of extensor digitorum longus were inserted into the superficial crural fascia. Thus, blood vessels, nerves and tendons were combined into the flap before transplantation. The composite flap was then transplanted into the recipient site of the electric injuries of hand to repair the long defects of the skin, blood vessels,nerves and tendons in one operation. The evaluation methods of the prognosis are the follows: the active motion function of finger was assessed by flexion and extension function of the fingers. The sensibility function was tested by the standards recommended by British Medical Association. RESULTS: The patients were followed up from 3 to 12 months. All the flaps were survived. Six months after operation, the flexion distance from tip to palmar crease and extension distance from tip to horizontal level of 3 patients were 4-5 cm and 3-4 cm respectively, and the other 2 patients were recovered from 6 cm and 5 cm to 4 cm and 4 cm respectively. The sensibility of finger skin reached to S2 level, and skin temperature rose. CONCLUSION: The free medial lateral crural composite flap was an ideal one to cure electric injuries at wrist, for it repairs skin, nerves, vessels and tendons defects in just one operation.