不同皮瓣修复虎口电烧伤的功能与美学效果比较

目的：比较三种皮瓣修复虎口电烧伤的功能与美学效果。方法：本组共有13例15处虎口电烧伤，在臂丛神经阻滞麻醉下急诊清创，依据伤口情况，分别采取3种皮瓣修复。①设计以第一掌背动脉为蒂的示指背皮瓣，宽约5cm，远端达近侧指间关节；可携蒂部分中指背皮肤，形成的皮瓣远端为双叶。②骨间背则动脉为蒂的前臂背侧逆行岛状皮瓣，通过腕部皮下隧道转移。③以旋髂浅或腹壁浅血管为蒂的同侧下腹部薄皮瓣带蒂转移，术后2周断蒂。全部病例随访6个月～3年，评价修复虎口功能与外形。结果：8例11处虎口电烧伤创面以第一掌背动脉皮瓣修复。4例4处虎口损伤以同侧前臂骨间背侧动脉逆行岛状皮瓣修复。1例以下腹部皮瓣带蒂转移修复。15例皮瓣转移后循环良好，创面Ⅰ期修复。1例前臂背侧岛状逆行皮瓣边缘因静脉回流障碍，皮瓣边缘0．5cm坏死。第一掌背动脉皮瓣和同侧前臂逆行皮瓣血运可靠，质地较薄，虎口修复后外形及功能良好。腹部皮瓣可提供较大面积修复组织，供区隐蔽，但修复后虎口外形和功能欠佳。结论：以同侧第一掌背动脉皮瓣或前臂骨间背侧动脉岛状皮瓣修复虎口电烧伤是比较理想的方法。

The comparison of the functional and esthetic result of different skin flaps in repairing the electrical burn of thumb-index web

Objective To compare the functional and esthetic results of three types skin flaps in repairing the electrical burn wounds of thumb-index web. Methods 13 patients suffered 15 electrical burn wounds of thumb-index web area were admitted into the observation. The wound was debrided by emergence operation under brachial plexus anesthesia. The skin flap of first type were designed upon the first dorsal metacarpal artery as main pedicle artery. The distal parts of the flaps reached the proximal interdigital joint with the breadth of about 5 cm. In some special cases, the flaps included the dorsal skin tissues of middle finger. The reverse island forearm flaps formed with a homolateral dorsal interosseous vascular pedicle were adopted as the second available flap type. After raised, the flaps were transplanted to reconstruct the damaged thumb-index web through a subcutaneous tunnel across the skin area of wrist and hand dorsum. The last type of skin flaps to repair the thumb-index web wound was low abdominal skin flap. All the cases were followed-up for 6 months to 3 years after final repair operation. Results 11 wounds in 8 cases were repaired with first dorsal metacarpal artery flaps. And 4 wounds in 4 cases with homolateral reverse island forearm flaps, and 1case with low abdominal skin flap. Except about 0.5cm distal part of one homolateral reverse island forearm flap showed necrosis, all the other flaps of first dorsal metacarpal artery and homolateral dorsal interosseous artery demonstrated a reliable blood supply and adequate thickness with the followed-up results of satisfactory appearance and function for the thumb-index web reconstruction. Although the low abdominal skin flap could provide larger area tissue to repair wounds, the reconstructed thumb-index web can't obtain an ideally needed functional and esthetic result. Conclusion For both the functional and esthetic considerations, the first dorsal metaearpel artery or homolateral dorsal interosseous artery supplying skin flaps are both available and ideal ways to repair the electrical wounds of thumb-index web area.