以旋髂浅动脉为蒂髂骨皮瓣修复手部掌骨与皮肤缺损的临床研究

发布时间：2018-02-13 17:14

本文关键词： 外科皮瓣髂骨移植旋髂浅动脉　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨以旋髂浅动脉为蒂的髂骨皮瓣修复手部掌骨与皮肤缺损的临床研究。方法:2011年以来,应用以旋髂浅动脉髂骨皮瓣同时修复手部掌骨与皮肤缺损6例,男5例,女1例;年龄19~55岁,平均30岁。冲压伤3例,铣床绞伤2例,挤压伤1例。其中第一掌骨缺损4例,第二掌骨缺损2例,6例皮肤缺损面积4.0cm×2.0cm~11.0cm×5.0cm,骨缺损长度5.0~8.0cm,伴有不同程度肌腱缺损,皮瓣切取大小5.0cm×3.0cm~12.0cm×6.0cm,髂骨切取大小6.0cm×0.7cm×0.6cm~8.5cm×0.9cm×0.8cm。血管吻合方式:2例皮瓣旋髂浅动脉与桡动脉端侧吻合,4例皮瓣旋髂浅动脉与桡动脉手背支端端吻合,旋髂浅动脉伴行静脉与桡动脉伴行静脉吻合,旋髂浅静脉与头静脉分支吻合;骨断端固定方式:钢板螺钉固定2例,克氏针固定4例;3例肌腱缺损的病例,通过移植掌长肌腱桥接修复。髂腹部供区均直接予以缝合。结果:术后10~12天,6例髂骨皮瓣顺利成活,伤口均一期愈合,术后14d皮瓣压力套治疗,预防皮瓣臃肿,外固定保护21d,骨愈合时间约1.5~2.5个月,全部患者随访6~13个月(平均9个月),皮瓣外观满意,患手恢复握持功能,恢复对掌、对指功能。髂腹部供区伤口Ⅰ期愈合,外形轮廓未改变,无深部感染、血肿、腹壁疝形成,线性瘢痕位于腹股沟韧带及髂嵴下方,下肢行走无不适,步态正常,1例因术中股前外侧皮神经受牵拉,术后大腿外侧皮肤感觉稍麻木,2个月自行恢复。结论:旋髂浅动脉髂骨皮瓣供区损伤小,切取简便,血运丰富,是修复手部掌骨合并皮肤缺损的一种理想方法。
[Abstract]:Objective: to investigate the clinical application of iliac flap pedicled with superficial iliac circumflex artery in the repair of metacarpal and skin defects of hand. Methods: since 2011, 6 cases (5 males) of metacarpal and skin defects of hand were repaired with iliac circumflex superficial iliac artery flap at the same time. One case was female, the age was 1955 years old with an average age of 30 years. There were 3 cases of punching injury, 2 cases of milling machine wound, 1 case of crush injury, 4 cases of the first metacarpal bone defect, 4 cases of the first metacarpal bone defect, The second metacarpal defect was found in 2 cases with skin defects of 4.0 cm 脳 2.0 cm and 11.0 cm 脳 5.0 cm, and the length of bone defects was 5.0 ~ 8.0 cm, accompanied by tendon defects of different degrees. The size of the flap was 5.0cm 脳 3.0cm, 12.0cm 脳 6.0cm, and the size of the iliac bone was 6.0cm 脳 0.7cm 脳 0.6cm ~ (-1) 8.5cm 脳 0.9cm 脳 0.8 cm 路cm ~ (-1). Vascular anastomosis was performed in 2 cases with superficial circumflex iliac artery and radial artery, 4 cases with superficial iliac circumflex artery anastomosed with the dorsal hand branch of radial artery. The superficial circumflex iliac artery combined with radial artery and radial artery were anastomosed, and the superficial iliac circumflex vein and cephalic vein were anastomosed. The graft of palmar longus tendon was used to repair the graft. The donor area of iliac abdomen was sutured directly. Results: 6 cases of iliac flap survived successfully on 10 and 12 days after operation, the wound healed in one stage, and the flap was treated with pressure cover 14 days after operation to prevent the skin flap from bloating. After 21 days of external fixation, the healing time of bone was 1.5 ~ 2.5 months. All the patients were followed up for 6 ~ 13 months (mean 9 months). The skin flap was satisfactory in appearance. The contour was not changed, there was no deep infection, hematoma, hernia of abdominal wall, linear scar was located below inguinal ligament and iliac crest, walking of lower extremity was unwell, and normal gait was 1 case being pulled by anterolateral femoral cutaneous nerve during operation. The skin of lateral thigh was slightly numb and recovered in 2 months. Conclusion: the iliac flap of superficial iliac circumflex artery is an ideal method for repairing the metacarpal bone with skin defect.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.2

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