手部创伤患者应用桡动脉掌浅支腕横纹游离皮瓣修复的临床效果观察

目的：探讨手部创伤患者应用桡动脉掌浅支腕横纹游离皮瓣修复的临床效果。方法回顾性分析我院2010年7月～2013年3月收治的20例（20指）手部创伤患者[男性14例，女性6例；年龄18～49岁，平均（33.8±12.5）岁]进行桡动脉掌浅支腕横纹游离皮瓣修复的临床资料，参照美国手外科推荐的系统评定方法评定屈伸肌腱疗效。结果术后对20例患者进行随访观察，随访6～12个月，平均（8.7±1.4）个月。有2指发生感染，2指皮瓣出现局部坏死，经过换药和对症处理后皮瓣均存活，感染得到控制；其余16指皮瓣外观良好，肿胀程度较轻，色泽与原手指皮肤接近。随访中：20指上皮化全部成功，X线检查骨折愈合良好；1指指甲再生缓慢，2指钩甲畸形，2指伤口恢复后触感觉较健侧迟钝。所有伤指在骨折及伤口愈合后经过适当的功能锻炼，手指关节活动均良好。所有患者在第6个月时进行手功能评价，优14例（70％）、良3例（15％）、中3例（15％）。结论手部创伤患者应用桡动脉掌浅支腕横纹游离皮瓣修复简便易行，术后患者皮瓣存活率高，手功能恢复好。

Clinical effect of free skin flap with superficial palmar branch in the repair of hand injury

Objective To investigate the clinical effect of free skin flap with superficial palmar branch in the repair of hand injury.Methods A retrospective analysis of the clinical data of 20 cases[14 males and 6 fe-males aged from 18-49 years with an average age of (33.8 ±12.5)years] of hand trauma patients in our hospital from Jul.2010 to Mar.2013 were carried out to observe the repair effect with TAM( total active movement) recom-mended by American Society for Surgery of the Hand.Results The 20 patients were followed up for 6-12 months [average,(8.7 ±1.4)months].Two patients suffered from infection and two from partial flap necrosis.All sur-vived by dressing and symptomatic treatment. Others were all healed with good skin flap appearance and slight swelling with a similar look to previous looks.All cases achieved good epithelization and X ray showed good heal-ing.Slow nail regeneration occurred in one case,2 developed nail deformity and 2 suffered weaker sense of touch. All cases achieved good function recovery with appropriate exercise after wound healing.Evaluation of hand function after 6 months showed excellent in 14 cases(70%),good in 3 cases (15%),fair in 3 cases (15%).Conclusion Free skin flap with superficial palmar branch in the repair of hand injury achieved good results with high survival rates and good function recovery.