皮瓣移植修复手指近中节软组织缺损的疗效观察

发布时间：2018-10-10 17:28

【摘要】：目的:探讨3种不同类型皮瓣移植修复手指近、中节软组织缺损的手术方法及疗效。方法:自2011年5月至2015年5月,应用3种不同类型皮瓣移植修复近中节手指软组织缺损102例115指,男59例70指,女43例45指;年龄19~62岁,平均45.6岁。其中游离腓动脉穿支皮瓣修复29例29指、游离尺动脉腕上穿支皮瓣35例37指、掌背动脉穿支逆行筋膜皮瓣修复38例49指。软组织缺损面积1.8 cm×4.0 cm~2.8 cm×5.4 cm。皮瓣切取面积2.0 cm×4.4 cm~3.1 cm×6.0 cm。术后从皮瓣成活率、手指功能及并发症等方面进行评价手术疗效。结果 :皮瓣全部存活,其中5例出现皮瓣远端表皮坏死,经创面换药治疗后愈合。供、受区未并发深部感染。其中有3例皮瓣供区出现植皮部分坏死,经换药治疗后延期愈合。所有患者获随访,时间6~28个月,平均10.6个月,皮瓣外形及质地良好,皮瓣感觉功能恢复良好,两点分辨觉为9~13 mm;供区无明显功能障碍。手指关节功能:优52例,良41,中9例。结论:对于手指近中节软组织缺损的修复,应根据患者性别和年龄差异、缺损创面情况、术者对手术方法的掌握程度以及医院技术条件等方面来选择合适的皮瓣。
[Abstract]:Objective: to investigate the surgical methods and efficacy of three different types of flaps for the repair of soft tissue defects in the proximal and middle segments of the fingers. Methods: from May 2011 to May 2015, 102 cases (59 cases, 70 fingers) and 43 women (45 fingers) of soft tissue defect of proximal middle segment were repaired with three different types of flaps, with an average age of 45.6 years (1962 years). Among them, 29 cases (29 fingers) were repaired with free peroneal artery perforator flap, 35 cases (37 fingers) with free ulnar artery perforating branch flap, and 38 cases (49 fingers) with retrograde fascial flap of dorsal metacarpal artery perforating branch. Soft tissue defect area 1.8 cm 脳 4.0 cm~2.8 cm 脳 5.4 cm. Flap area 2.0 cm 脳 4.4 cm~3.1 cm 脳 6.0 cm. The survival rate, finger function and complications of the flap were evaluated after operation. Results: all the flaps survived, of which 5 cases showed distal epidermal necrosis and healed after dressing change. Donor, the recipient area was not complicated with deep infection. There were 3 cases of partial necrosis of skin graft in the flap donor area and delayed healing after dressing change. All the patients were followed up for 6 ~ 28 months (mean 10.6 months). The skin flap had good appearance and texture, and the sensory function of the flap recovered well. Finger joint function: excellent 52 cases, good 41 cases, middle 9 cases. Conclusion: for the repair of soft tissue defect of proximal middle segment of finger, the appropriate flap should be selected according to the difference of sex and age of the patient, the condition of defect wound, the mastering degree of operation method and the technical condition of hospital, etc.
【作者单位】：杭州市西溪医院骨科;
【分类号】：R658.2

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