邻指岛状皮瓣桥接修复伴血管缺损的手指皮肤缺损

发布时间：2018-03-29 17:55

本文选题：外科皮瓣　切入点：指损伤　出处：《苏州大学》2015年硕士论文

【摘要】：目的:探索邻指指固有动脉岛状皮瓣转移桥接修复伴有指固有动脉缺损的手指皮肤软组织缺损的方法及疗效。方法:自2005年6月至2015年5月,对我院23例伴有指固有动脉缺损的手指皮肤软组织缺损患者,应用邻指指固有动脉岛状皮瓣转移桥接修复。本组年龄15~58岁,平均38岁。损伤原因:热压伤6例,冲压伤6例,机器碾轧伤9例,齿轮绞伤2例。损伤部位:示指近节6例,中节3例;中指近节5例,中节2例;环指近节2例,中节2例;小指近节3例。创面均伴有肌腱或骨外露,其中5例伴有指骨骨折,7例伴有肌腱断裂,4例同时伴有指骨骨折及肌腱断裂,远端指体血运障碍。4例伴有双侧指神经缺损,14例伴有单侧指神经缺损。创面面积为1.2cm×1.3cm~2.0cm×2.6cm。血管缺损的长度为1.5cm~3.0cm。皮瓣切取面积为1.5cm×1.5cm~2.2cm×3.0cm。供区创面取全厚皮片植皮。结果:术后23例皮瓣全部存活,远端指体血运恢复,供区植皮全部存活。术后随访6~36个月,皮瓣质地柔软,颜色与患指周围皮肤接近,无明显臃肿,外观满意。患指存活良好,无明显萎缩。依据手指屈伸功能总活动度(TAM)系统评估标准评价患指主动活动范围,16指TAM240°~265°,属优;5指TAM205°~215°,属良;2指TAM185°~190°,属中;总优良率91.3%。术后供区创面植皮11例有少许色素沉着,无明显瘢痕挛缩及畸形,功能无明显影响。结论:应用邻指岛状皮瓣修复伴指固有动脉缺损的手指皮肤缺损,一次手术既可以完成创面的修复,又桥接了指固有动脉的缺损,是修复此类损伤的较理想的方法。
[Abstract]:Objective: to explore the method and effect of repairing finger skin and soft tissue defect with finger proper artery defect by island flap of adjacent finger propria artery from June 2005 to May 2015. 23 cases of finger skin and soft tissue defect with defect of digital artery were repaired with the island flap of adjacent finger proper artery. The age of this group was 1558 years old (mean 38 years). The causes of injury included hot compression injury in 6 cases and punching injury in 6 cases. There were 9 cases of mechanical crush and 2 cases of gear twisting. The site of injury was 6 cases of proximal finger, 3 cases of middle segment, 5 cases of proximal segment of middle finger, 2 cases of middle segment, 2 cases of proximal ring finger, 3 cases of proximal little finger. Among them, 5 cases were accompanied by fracture of phalangeal bone and 7 cases with rupture of tendon, 4 cases with fracture of phalangeal bone and rupture of tendon. There were 14 cases with bilateral digital nerve defect and 14 cases with bilateral digital nerve defect. The wound area was 1.2cm 脳 1.3cm~2.0cm 脳 2.6 cm, the length of vascular defect was 1.5 cm ~ 3.0cm. The area of flap was 1.5cm 脳 1.5cm~2.2cm 脳 3.0 cm. All the 23 cases of flap survived. The distal phalanx recovered and the donor skin graft survived. The skin flap was soft in texture, close to the skin around the affected finger, and had no obvious bloated appearance. There was no obvious atrophy. According to the systematic evaluation criteria of total flexion and extension of fingers, the range of active movement was assessed as TAM240 掳265 掳, TAM205 掳215 掳, TAM185 掳190 掳, the total excellent and good rate was 91.3%. There was a little pigmentation in 11 cases of grafted skin after operation. There is no obvious scar contracture and deformity, and the function is not obviously affected. Conclusion: the repair of finger skin defect with finger proper artery defect by using the adjacent finger island flap can not only complete the repair of the wound surface, but also bridge the defect of the finger proper artery. It is an ideal method to repair this kind of injury.
【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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