手部皮神经营养血管筋膜蒂皮瓣修复手指热压伤的研究

目的 探讨手背皮神经营养血管筋膜蒂皮瓣修复手指热压伤的可行性及临床效果。方法 手指热压伤伴肌腱及指骨外露患者36例共47指。应用拇指背侧皮神经、掌背皮神经、指固有神经背侧支、尺神经手背支的营养血管筋膜蒂皮瓣修复；并将皮瓣内皮神经与受区内指神经行外膜吻合,重建受区感觉。结果 转位皮瓣全部成活,术后出现1例轻度感染,3例皮瓣部分坏死,经换药及清创后愈合良好；经吻合神经后,皮瓣能恢复部分感觉。结论 手部皮神经营养血管筋膜蒂皮瓣手术操作简单、可一次完成、皮瓣外形良好,部分皮瓣能恢复感觉,是修复手指热压伤的理想方法。

Neurofaciocutaneous flaps for repairing finger hot crush injuries

Objective To investigate the feasibility and clinical result of neurofaciocutaneous flaps in repairing finger hot-crush injury. Methods Thirty-six cases(47 fingers) of finger hot-crush injury with tendon and bone exposure were repaired by using ipsolateral dorsal metacarpal neurovascular, dorsal thumb neurovascular, dorsal digit neurovascular, and dorsal ulnar superficial neurovascular fasciocutaneous flaps. The sense areas were rebuilt by dovetailing the cutaneous nerve and digital nerve. Results All flaps survived. Mild infection and partial necrosis of the flaps occurred in 1 and 3 cases, respectively. The complications were relieved after changing dressing. At the final follow-up, the flaps with nerve dovetailed acquired partial sense. Conclusion This single-stage completed surgical procedure provides satisfactory flap in appearance and function with a recovery of partial sense, suggesting that it is an ideal method for repairing the finger hot-crush injury.