手指指端皮肤软组织缺损皮瓣修复的临床研究

发布时间：2018-11-03 10:20

【摘要】：目的：1、了解指端软组织解剖特点。 2、了解V-Y推进皮瓣、指动脉逆行岛状皮瓣、指动脉顺行岛状皮瓣、筋膜皮瓣的临床疗效，为指端伤提供一个好的治疗手段。方法：临床统计自2013年1月至2013年6月我们分别V-Y推进皮瓣、指动脉逆行岛状皮瓣、指动脉顺行岛状皮瓣、指背筋膜皮瓣采用4种皮瓣修复手指（包括拇指）指端皮肤缺损。患者42例46指，男31例，女11例，年龄8岁~60岁，平均40岁，其中拇指6指，食指20指，中指11指，环指6指，小指3指。皮肤缺损面积平均为10.0mm×8.5mm(5.0mm×6.0mm~12.0mm×15.0mm)。致伤原因包括爆炸伤1例、冻伤1例、切割伤15例、挤压伤6例，重物砸伤19例。42例患者经患指清创后皆伴末节指骨外露或缺损，其中伴末节指骨爪粗隆以远缺损者8指，末节指骨中份水平以远缺损者13指，末节指骨完整者15指，伴甲床、甲板部分缺损者10指。其中采用V-Y推进皮瓣修复22指，指动脉逆行岛状皮瓣6指，指动脉顺行岛状皮瓣11指，指背筋膜皮瓣7指。按照中华医学会手外科学会上肢部分功能评定试用标准[5]：无畸形，感觉及功能正常或基本正常为优；轻中度畸形，感觉及运动功能大部分正常或部分正常为良；畸形明显，感觉及功能丧失为差。结果：术后随访3~6个月，皮瓣一期成活46指，其中2例出现指端皮瓣远端变黑变硬部分坏死。坏死指端皮瓣给予去除干瘪部分，保留软组织待肉芽组织长出后自行覆盖创面。8指皮瓣出现颜色暗紫，肿胀明显等静脉危象，，经肝素抗凝、间断性小切口放血、抬高患肢、烤箱保暖、蒂部拆除缝线等对症处理后，8例指端皮瓣均好转。46例成活皮瓣质地柔软，外观较好，颜色与周围正常皮肤相近，全部恢复保护性感觉，手指功能基本正常，能胜任日常工作。按照中华医学会手外科学会上肢部分功能评定试用标准[5]：优：33例，良9例，差4例。结论：V-Y推进皮瓣、指动脉逆行岛状皮瓣、指动脉顺行岛状皮瓣及指背筋膜皮瓣4种皮瓣是修复手指（包括拇指）指端皮肤缺损的较好选择，应根据皮肤缺损情况选择适合的皮瓣予以修复。
[Abstract]:Objective: 1. To understand the anatomical characteristics of soft tissue at the fingertip. 2. To understand the clinical effect of V-Y advancing flap, reversed digital artery island flap, digital artery anterograde island flap and fascial flap, and to provide a good treatment for finger tip injury. Methods: from January 2013 to June 2013, the V-Y advancing flap, the reversed digital artery island flap, the digital artery anterograde island flap, and the digital artery anterograde island flap were analyzed. The skin defect of finger (including thumb) was repaired by four kinds of skin flaps. There were 42 patients with 46 fingers, 31 males and 11 females, aged from 8 to 60 years old, with an average age of 40 years. There were 6 thumbs, 20 index fingers, 11 middle fingers, 6 ring fingers and 3 little fingers. The average area of skin defect was 10.0mm 脳 8.5mm (5.0mm 脳 6.0mm~12.0mm 脳 15.0mm). The causes of injury included explosive injury in 1 case, frostbite in 1 case, incised injury in 15 cases, crush injury in 6 cases and heavy object injury in 19 cases. The distal phalangeal bone in 13 fingers, complete phalangeal bone in 15 fingers, and partial defect in nail bed and deck in 10 fingers. Among them, 22 fingers were repaired with V-Y propulsion flap, 6 fingers with reversed digital artery island flap, 11 fingers with anterograde digital artery island flap and 7 fingers with dorsal fascia flap. According to the evaluation criteria of upper limb function of the Chinese Medical Association of hand surgery [5]: no malformation, normal sensation and function or basic normal, mild to moderate malformation, most normal or partial normal sensory and motor function were good. The deformity was obvious and the loss of sensation and function was poor. Results: after 3 ~ 6 months follow up, 46 fingers survived in one stage of the flap, 2 of which showed the necrosis of the distal end of the flap. The necrotic phalanx flap was given to remove the dry part and retain the soft tissue to cover the wound after the granulation tissue grew. The skin flap of 8 fingers appeared dark purple color, swelling and obvious venous crisis. It was treated with heparin anticoagulant, intermittent small incision bleeding, raised the affected limb, After the oven was warm and the suture was removed from the pedicle, all the 8 fingertip flaps were improved. 46 cases survived the skin flap with soft texture, good appearance, similar color to the surrounding normal skin, all of them recovered the protective feeling, and the finger function was basically normal. Be able to do daily work. According to the evaluation criteria of upper limb function of the Chinese Medical Association, 33 cases were excellent, 9 cases were good and 4 cases were poor. Conclusion: the V-Y advancing flap, the reversed island flap of digital artery, the anterograde island flap of digital artery and the dorsal fasciocutaneous flap of the finger are the better choice for repairing the skin defect of finger (including thumb). The skin flap should be selected according to the condition of skin defect.
【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】：R658.2

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