游离双侧“手枪”状股前外侧皮瓣瓦合修复全手脱套伤的可行性研究

发布时间：2018-08-12 19:40

【摘要】：目的：探索游离双侧“手枪”状股前外侧皮瓣一期一次性瓦合修复全手脱套伤的可行性。方法：本研究包括建立模型、活体测量实验、尸体模拟修复实验以及临床应用4部分。建立模型：选取2具无手部残疾和疾病的新鲜尸体标本,选左手为模型手。以腕部远侧腕横纹、拇指桡侧、小指尺侧侧中线为界,于伸屈肌腱表面完整切除掌、背侧2部分皮肤,形成全手脱套伤伤情模型。在伤情模型基础上,保留基本手功能单位(包括手掌、手背、全拇指和保留指浅屈肌腱止点的中指中节中部以近部份),余手指于掌指关节平面以远截除,形成修复模型。将修复模型创面分为掌侧区和背侧区2部分,设想用双侧股前外侧皮瓣分别修复掌侧区和背侧区。活体测量实验：随机选取50例(男、女各25例)健康、无手部残疾和疾病的成年人,根据修复模型,分别测量基本手功能单位的掌侧区和背侧区皮肤的纵长和横宽；查阅相关股前外侧皮瓣的专业教材以及文献,得到股前外侧皮瓣最大可切取纵长、横宽；统计学处理,比较股前外侧皮瓣与基本手功能单位掌侧区、背侧区各皮肤径线的大小。尸体模拟修复实验：根据修复模型创面形状在大腿供区设计切取双侧“手枪”状股前外侧皮瓣瓦合修复模型手,观察修复效果。临床应用：重点阐述供区皮瓣与受区患手血供及感觉的建立方法和注意事项。结果：基本手功能单位掌侧区皮肤纵长为13.84±0.88cm,横宽为14.48±1.11cm。背侧区皮肤纵长为12.15±1.09cm,横宽为14.92±1.11cm。查阅资料得股前外侧皮瓣最大可切取纵长为30.59±6.21cm,横宽为16.33±3.27cm。结果显示：股前外侧皮瓣可切取纵长、横宽均大于基本手功能单位掌、背侧区皮肤的纵长、横宽。根据修复模型创面形状设计及切取双侧“手枪”状股前外侧皮瓣,修复“修复模型”,获得了满意的修复手外形。结果提示：双侧“手枪”状股前外侧皮瓣瓦合后能覆盖全手脱套伤修复模型创面。结论：瓦合双侧“手枪”状股前外侧皮瓣能一期一次性修复全手脱套伤。修复手拥有基本手功能和较满意的外形。
[Abstract]:Objective: to explore the feasibility of one-stage tipping with free bilateral "pistol" anterolateral thigh flap to repair the whole hand degloving injury. Methods: this study included four parts: model establishment, in vivo measurement experiment, cadaveric simulated restoration experiment and clinical application. Model: two fresh cadavers without hand disability and disease were selected and left hand was chosen as model hand. The lateral striae of wrist, the radial side of thumb and the middle line of ulnar side of small finger were taken as the boundary, the palmar was removed completely on the surface of extensor and flexor tendon, and 2 parts of skin were removed from the dorsal side to form the injury model of the whole hand. On the basis of injury model, the basic functional units of hand (including palm, back of hand, total thumb and middle segment of middle finger of flexor digitorum tendinum) were retained, and the remaining fingers were amputated from the metacarpophalangeal joint to form a repair model. The model wounds were divided into two parts: metacarpal region and dorsal region. Bilateral anterolateral femoral flap was used to repair the metacarpal region and dorsal area respectively. In vivo measurement experiment: 50 healthy adults (25 males and 25 females) without hand disability and disease were randomly selected to measure the longitudinal length and transverse width of the palmar and dorsal regions of the basic hand functional units according to the repair model. The length and width of the anterolateral thigh flap were obtained by consulting the relevant teaching materials and literature. Statistical analysis was made to compare the diameter of each skin line between the anterolateral femoral flap and the basic functional units of the hand palmar and dorsal. Simulated repair experiment of cadaver: according to the shape of repairing model wound, the model hands of bilateral "pistol-like" anterolateral thigh flap were designed in the thigh donor area to observe the effect of repair. Clinical application: the establishment method and attention of blood supply and feeling of donor flap and recipient hand were expounded. Results: the longitudinal length and transverse width of the palmar area were 13.84 卤0.88 cm and 14.48 卤1.11 cm respectively. The longitudinal length and transverse width of dorsal skin were 12.15 卤1.09 cm and 14.92 卤1.11 cm respectively. The maximum longitudinal length and transverse width of anterolateral femoral flap were 30.59 卤6.21 cm and 16.33 卤3.27 cm respectively. The results showed that the longitudinal length and transverse width of the anterolateral thigh flap were larger than those of the basic hand functional unit palmar and the longitudinal and transverse width of the dorsal skin. According to the shape of the repair model, the bilateral "pistol-like" anterolateral thigh flap was designed and cut, and the "repair model" was repaired. The satisfactory hand shape was obtained. The results suggest that bilateral "pistol" anterolateral thigh flap can cover the wound surface of the model. Conclusion: bilateral "pistol" anterolateral thigh flap can be used to repair the whole hand degloving injury in one stage. The repair hand has basic hand function and satisfactory shape.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.2

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