全手皮肤脱套伤的基础与临床应用研究

发布时间：2018-07-03 09:56

本文选题：手损伤 + 脱套伤　；参考：《苏州大学》2015年硕士论文

【摘要】：目的:制作全手皮肤脱套伤的尸体模型,分析41例全手皮肤脱套伤临床病例,寻找和总结全手皮肤脱套伤的伤情特点,提出全手皮肤脱套伤的临床分型,探索新的治疗方法。方法:采用6具福尔马林浸泡及红色乳胶灌注的成人尸体上、下肢标本各12侧,在肉眼及手术显微镜下进行解剖及模拟操作,并制作成全手皮肤脱套伤模型。回顾性分析1999年以来我院收治的全手皮肤脱套伤病例41例,分析和总结全手皮肤脱套伤的伤情特点,提出临床分型,并根据不同的分型制定相应的治疗方案。临床上应用带足部皮瓣的趾甲瓣或第二趾修复全手皮肤脱套伤21例。应用吻合血管的回植术治疗全手皮肤脱套伤19例。应用腹部皮瓣或瓦合皮瓣修复全手皮肤脱套伤14例。结果:临床解剖学资料显示,足背动脉在足背部的主要分支有跗外侧动脉、外踝前动脉、跗内侧动脉、内踝前动脉及第1跖背动脉等;可以形成以足背动脉为主干,分别以各个皮肤穿支,并携带足背皮瓣的姆甲皮瓣、第二趾甲皮瓣、第二趾修复全手皮肤脱套伤。根据全手皮肤脱套伤的伤情特点,将全手皮肤脱套伤根据其伤情特点分成5型,并制定相应的治疗方案。临床上应用以足背动脉为主干的皮瓣携带趾甲瓣修复全手皮肤脱套伤21例,其中19例获随访6~36个月,修复后的全手保留2-3个手指,可以恢复手的抓捏、持物等基本功能,对足的行走无明显影响。临床上应用吻合血管的回植术修复全手皮肤脱套伤19例,5例完全成活者,手的屈伸、抓捏、拇指对掌等功能恢复满意,2例完全坏死者,手功能完全丧失,其余病例均恢复部分手功能。临床上应用腹部皮瓣或瓦合皮瓣修复全手皮肤脱套伤14例,14例均保留了5个手指,手部可以恢复基本抓持功能。结论:全手皮肤脱套伤虽然有多种方法进行修复,而要想做到既要恢复美观的外形,又要重建良好的功能,而且对供区损伤又小,从目前的各种治疗方法来看,仍没有一个最佳的方案,但是对拇指进行单独的修复能够获得相对比较满意的疗效,也是目前学者比较一致的看法。对全手皮肤脱套伤的治疗要遵循以下几点:(1)脱套皮肤完整能进行再植的要先予以再植,再植后的功能外形最好;(2)脱套皮肤毁损或缺损而无法进行再植的则予以再造加皮瓣修复;(3)拇指要进行单独修复,并重视虎口的重建以利于功能的恢复;(4)修复后的手掌侧皮肤质地要薄,而且要有感觉;(5)再造的手指不在于多,而在于精,一般再造中(环)指或中环指同时再造就能满足患者要求;(6)要重视供区的损伤问题,供区要隐蔽,而且对供区的损伤尽量减到最小;(7)利用显微外科方法与传统的方法相结合的方法,可以有效的降低供区损伤问题。(8)要根据不同的伤情、年龄、性别、个体要求、技术水平等情况进行综合考虑,制定个性化的手术方案。
[Abstract]:Objective: to make the cadaveric model of the whole hand skin degloving injury, analyze 41 cases of the whole hand skin degumming injury, search for and summarize the characteristics of the whole hand skin degumming injury, put forward the clinical classification of the whole hand skin degloving injury, and explore a new treatment method. Methods: six adult cadavers soaked in formalin and infused with red latex were used to dissect and simulate the operation under naked eye and operation microscope on 12 sides of lower limbs. A retrospective analysis was made on 41 cases of total hand skin degumming injury admitted in our hospital since 1999. The characteristics of the injury were analyzed and summarized, and the clinical classification was put forward, and the corresponding treatment plan was made according to the different types. 21 cases were treated with toenail flap or second toe with foot flap. Vascular anastomosis was used to treat 19 cases of whole hand skin injury. Abdominal skin flap or tile flap were used to repair 14 cases of hand skin degloving injury. Results: the main branches of dorsalis pedis artery in dorsum pedis were lateral tarsal artery, lateral anterior malleolus artery, medial tarsal artery, medial anterior malleolus artery and first dorsal metatarsal artery. The second toe was used to repair the skin loss of the whole hand with each perforating branch of the skin and the skin flap carrying the dorsal foot flap. According to the characteristics of the whole hand skin degloving injury, the whole hand skin degloving injury was divided into 5 types according to the characteristics of the injury, and the corresponding treatment scheme was established. 21 cases were treated with pedicle flap with pedicle nail flap, 19 of which were followed up for 636 months. After the repair, 2-3 fingers were retained in the whole hand, which could restore the basic functions of the hand, such as clasping and holding objects, and so on, after the repair, the skin flap with toenail flap was used to repair the skin loss of the whole hand, among which 19 cases were followed up for 636 months. There was no obvious effect on foot walking. Clinical application of vascular anastomosis in the repair of 19 cases of total hand skin removal injury 5 cases of complete survival, hand flexion and extension, clasping, thumb and other functions recovered satisfactory in 2 cases of complete necrosis of the hand, the hand function is completely lost. All the others recovered some hand function. Clinical application of abdominal skin flap or tile flap for the repair of 14 cases of total hand skin removal injury 14 cases all retained 5 fingers can restore the basic grasp of the hand function. Conclusion: although there are many methods to repair the whole hand skin degloving injury, it is necessary to restore the beautiful appearance and rebuild the good function, and the injury to the donor area is small. There is still no optimal scheme, but it is a relatively satisfactory result to repair the thumb alone, which is the consensus of scholars at present. The following points should be followed in the treatment of the whole hand skin degloving injury: (1) if the skin can be completely replanted, it should be replanted first. After replantation, the functional appearance is the best; (2) if the skin is damaged or damaged, the skin can not be replanted and then the flap is reconstructed; (3) the thumb should be repaired alone. And pay attention to the reconstruction of the tiger's mouth in order to facilitate the recovery of function; (4) the skin of the repaired palm should be thin and sensed; (5) the reconstructed fingers are not more, but more refined. In general, reengineering means (ring) or ring (ring) can meet the needs of patients at the same time; (6) attention should be paid to the injury of donor areas, which should be concealed. And the injury of donor area is minimized as far as possible. (7) the problem of donor area injury can be effectively reduced by using microsurgical method combined with traditional method. (8) according to different injury situation, age, sex, individual requirements, The technical level is considered synthetically, and the individualized operation plan is established.
【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

【参考文献】