摘要
目的总结采用上臂内侧双叶游离皮瓣修复手部2处皮肤软组织缺损的效果。方法2014年5月—2016年5月,徐州仁慈医院收治7例手部2处皮肤软组织缺损伴指骨、肌腱外露患者,其中男5例、女2例,年龄19~41岁。每处缺损面积为3.0cm×1.5cm^6.0cm×3.0cm,采用上臂内侧双叶游离皮瓣修复,皮瓣单叶面积为4.0cm×2.0cm^8.0cm×3.5cm,供区均直接缝合。记录皮瓣成活情况;随访观察供受区恢复情况,测量皮瓣两点辨别觉距离,采用中华医学会手外科学会上肢部分功能评定试用标准评定手功能。结果本组皮瓣均顺利成活,创面及供区切口均愈合。患者均获随访,随访时间6~15个月,皮瓣颜色及质地与周围正常皮肤相似,外形较佳;供区无明显瘢痕,肘关节功能正常。1例患者术后1个月出现手尺侧麻木,经营养神经、局部理疗等治疗3个月后缓解。术后6个月,皮瓣两点辨别觉距离为5.5~8.0mm,手功能评定获优3例、良3例、中1例。结论上臂内侧双叶游离皮瓣质地、外观较佳,供区瘢痕隐蔽,是修复手部2处皮肤软组织缺损的较佳方法。
Objective To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.
作者
黎章灿
郑大伟
齐伟亚
朱辉
石荣剑
寿奎水
Li Zhangcan;Zheng Dawei;Qi Weiya;Zhu Hui;Shi Rongjian;Shou Kuishui(Department of Hand Surgery, Xuzhou Renci Hospital, Xuzhou 221004, China;Department of Hand Surgery, Wuxi Hand Surgery Hospital, Wuxi 214062 , China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2019年第8期604-607,共4页
Chinese Journal of Burns
关键词
创伤和损伤
伤口愈合
外科皮瓣
手
Wounds and injuries
Wound healing
Surgical flaps
Hand
