手部皮肤软组织缺损的修复

目的 探讨手部皮肤软组织缺损的修复方法。方法 １９９８年以来采用１８种方法如传统带蒂皮瓣、原位带血管蒡逆行（岛状）皮瓣、前臂带血管蒡逆行（岛状）皮瓣、游离皮瓣和“瓦合皮瓣”等修复手部创面２３９例。结果 ５例逆行指动脉岛状皮瓣有瘀血,表皮水泡形成;ｖ－ｙ皮瓣和前臂背侧骨间动脉逆行（岛状）皮瓣各１例血循障碍坏死再次植次修复;１６８例经术后６～１２个月随访复查,效果尚效果。结论 以１８种不同的修复方法处理２３９例手部创面,对不同部位不同创面的修复提供了有益的经验。认为传统带蒡皮瓣因操作简单,安全实用仍是在层医院主要的修复方法。“瓦合皮瓣”在全手套脱伤的修复中具有明显优点,值得推广应用。在有较优良显微外科操作技巧的医院,可适当增加游离皮瓣修复手部创面的比例,以期一次完成创面修复和功能重建及外观美容。

REPAIR FOR SOFT TISSUE DEFECT OF HAND

Object To investigate the repairing methods of soft tissue defect of band. Methods 239 cases with soft tissue defects of hand were treated with 18 kinds of flaps include the traditional pedical flap. the vascular pedical flap. foe free flap and" two flap are formed to enclose the bony stump" flap. Results The flaps completely survived in 237 cases. One case with V - Y flap and the other case with revere dorsal forearm interosseous artery flap were necrosed. The results were satisfactory after 6 - 12 months follow up in 168 cases. Conclusions this article provided some beneficial experience in repairing different kinds of soft tissue defect of hand. Traditional pedicle flap is easy to elevate and safty. "Two flaps are formed to enclose the bony stump" flap has a practical value in the full hand avulsion repairment. Applicacion of free flap can achieve good otline and function result.