腹部皮瓣瓦合足背皮瓣修复手部严重皮肤脱套伤

目的报道利用腹部带蒂皮瓣瓦合足背游离皮瓣移植修复手部严重脱套伤的手术方法及,临床疗效。方法2003年2月～2010年6月．收治手部严重脱套伤患者9例。彻底清创后2—5指末节或中节中部平面以远指骨截除,创面先采用腹部带蒂皮瓣包埋手部创面,3～4周后行腹部皮瓣断蒂,并用腹部皮瓣覆盖手（指）背侧创面,游离足背皮瓣修复手（指）掌侧创面,足背供区行游离植皮术。皮瓣成活后3个月、6个月分别行手指分指术。结果术后9例手掌、手背皮瓣均顺利成活,伤口均一期愈合,足部供区植皮区及腹部供区伤口一期愈合。随访以最后一次分指术后开始计算,时间为6～48个月．平均15个月。手掌、手背皮瓣无臃肿。2—5指掌指关节活动为0°-80°,指间关节僵直于伸直位,2—5指可完成与拇指的对指、对捏等功能。手（指）背皮瓣感觉恢复为S1-S2,手（指）掌皮瓣感觉恢复为S2～S3＋。足背供区及腹部无明显瘢痕挛缩,行走无明显影响。结论利用腹部带蒂皮瓣瓦合足背游离皮瓣移植修复手部严重脱套伤,可以修复手部创面,重建手部分功能,是一种较好的治疗方法。

Repair severe hand degloving injury by combining abdominal flap and dorsal foot skin flaps

Objective To report surgical methods and clinical efficiency of repairing severe hand degloving injury by combining abdominal flaps and free dorsal fooot skin flaps. Methods From February 2003 to June 2010, 9 patients with severe fingers degloving injury were treated, 7 males and 2 females. After complete debridement, distal or the middle section of middle joints and distal phalanges were amputated, then the wound was embedded with abdominal pedicle flaps. 3 -4 weeks later, the pedicles were removed. The wound of the hand back was covered with abdominal flaps and the wound in the palm side of the fingers was repaired with free dorsal foot skin flap. The donor site of foot was covered with free skin grafting. The surgery for separating fingers was separately given after 3 and 6 months. Results After surgery, the flaps of the palm and back of the hand all successfully survived in these 9 cases, with primary wound healing. The wounds in grafting region of foot donor site and abdominal donor site also had primary healing. Followed-up started at the last surgery for separating fingers, about 6-48 months, an average of 15 months, there were no swollen in the palm and back. The joint activity of metacarpophalangeal joints of 2-5 fingers was 0-80 degree. The interphalangeal joint stiffness lied in extension position. 2-5 fingers recovered opposing and pinching function with thumb. The sensory function was recovered to S1-S2 for the flaps of back of the hand （fingers）, and to S2-S3＋ for the flaps of the palm of the hand （fingers）. There was no obvious scar contracture in the foot and abdominal donor sites and no significant effect on walking. Conclusions It is a better treatment for repairing severe hand degloving injury by combining abdominal pedicle flaps and dorsal foot free flaps. It can repair the hand wound and reconstruct part of the hand function.