游离指腹再植与再造的临床研究

发布时间：2018-02-21 20:34

本文关键词： 指腹再植游离皮瓣再造　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨指腹损伤后再植及指腹缺损后再造的方法，对比各种指腹重建方法的临床治疗效果。方法：总结我院2004年至2014年间收治的指腹损伤或缺损的53例病例，分别采用指腹再植和六种皮瓣进行修复，其中指腹再植7例，V-Y推进皮瓣18例，带蒂髂腹股沟皮瓣4例，指动脉逆行岛状皮瓣6例，，大鱼际筋膜皮瓣5例，邻指皮瓣11例，游离拇趾腓侧皮瓣2例，并对其随访6～24个月，平均11个月，比较临床效果。结果： 53指指腹损伤及缺损的病例再植和再造完全成活51指，两例大鱼际筋膜皮瓣部分成活，经换药后创面延期愈合。术后，1例游离足拇趾腓侧皮瓣、1例指动脉逆行岛状皮瓣、2例V-Y推进皮瓣出现静脉或动脉危象，均给予减张处置后皮瓣血运恢复正常，继而顺利成活。随访时间6～24个月，平均11个月。术后6月，再植的指腹和6种皮瓣重建的指腹两点辨别觉（χ±s)及晚期综合疗效的优良率（%）:游离指腹再植4.61±0.27mm、100.0%，V-Y推进皮瓣5.72±0.36mm、83.3%，指动脉逆行岛状皮瓣7.22±0.32mm、83.3%，大鱼际筋膜皮瓣7.52±0.45mm、80.8%，邻指皮瓣7.44±0.42mm、81.8%，游离拇趾腓侧皮瓣5.25±0.21mm、100.0%；带蒂髂腹股沟皮瓣13.1±3.17mm、25%。结论： ①指腹作为人体与外界接触的敏感区，当损伤后应该尽量再植或完美地修复和重建。②手指指腹损伤后的修复方法很多，应根据患者的年龄、性别、职业、供区副损伤、组织与指腹的相似度，以及术者的显微外科技术水平进行综合选择。③游离足拇趾腓侧皮瓣移植再造的指腹，无论从外观、质地、感觉还是血运上看均达到逼真的效果，应作为指腹重建的首选方法。
[Abstract]:Objective:. To discuss the methods of replantation after finger abdominal injury and reconstruction of finger abdominal defect, and to compare the clinical effect of various reconstruction methods of finger abdomen. Methods:. From 2004 to 2014, 53 cases of finger abdominal injury or defect were treated in our hospital. Replantation of finger abdomen and six kinds of flaps were performed respectively. Among them, 7 cases were treated with V-Y advancing flap and 4 cases with pedicled ilioinguinal flap. There were 6 cases of reversed island flap of digital artery, 5 cases of great thenar fascial flap, 11 cases of adjacent finger flap and 2 cases of free fibular flap of hallux. The follow-up was 6 ~ 24 months (mean 11 months), and the clinical effect was compared. Results:. In 53 cases of finger abdominal injury and defect, 51 fingers were completely replanted and reconstructed, and 2 cases were partially survived by thenar fasciocutaneous flap. After dressing change, the wound healing was delayed. After operation, 1 case of free toe peroneal flap and 1 case of digital artery retrograde island flap and 2 cases of V-Y advancing flap appeared venous or arterial crisis, and the blood supply of the flap returned to normal after the treatment of tension reduction. The follow-up time was 6 ~ 24 months (mean 11 months). The excellent and good rate of the replanted finger abdomen and 6 kinds of flaps for the reconstruction of the two points of finger abdomen (蠂卤s) and the comprehensive curative effect in the late stage are as follows: the free finger replantation 4.61 卤0.27 mm ~ 100.010. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 5 + 0. 36 mm advance flap, the island flap of the digital artery 7.22 卤0. 32 mm 83.3, the great thenar fasciocutaneous flap 7. 52 卤0. 45 mm, the adjacent finger flap 7. 44 卤0. 42 mm and 81.8 mm, the free finger flap 7. 44 卤0. 42 mm and 81.8 mm, respectively. The fibular flap was 5.25 卤0.21 mm and the pedicled ilioinguinal flap was 13.1 卤3.17 mm. Conclusion:. (1) the finger abdomen is a sensitive area of human body contact with the outside world. After the injury, the repair methods of finger abdomen injury should be replanted or reconstructed perfectly. 2. The repair methods should be based on the patient's age, sex, occupation and collateral injury of donor area. The similarity between tissue and finger abdomen, as well as the microsurgical technique level of the operator, were used to select 3 free toe peroneal flap graft to reconstruct the finger abdomen. The results were realistic in terms of appearance, texture, feeling and blood flow. It should be the first choice method of abdominal reconstruction.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.1

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