CAJ | 학술논문

目的总结几种皮瓣移植术治疗重度虎口挛缩的效果.方法针对2000年9月至2009年3月收治的重度虎口挛缩的32例病例,应用超薄型髂腹股沟皮瓣、血管蒂逆行岛状皮瓣、神经营养血管蒂皮瓣及游离皮瓣予以治疗,皮瓣面积3.0 cm×5.0 cm～4.5 cm×8.0 cm,术后随访3～12个月,观察其治疗结果.结果 1例神经营养血管蒂皮瓣和1例超薄型髂腹股沟皮瓣远端部分坏死,后经游离植皮术创面愈合,其余皮瓣均完全成活,部分病例术后拆除克氏针固定后虎口有部分程度回缩,虎口角平均为70°(45°～80°),虎口宽度平均为50 mm(35～60 mm),为健侧的80%,挛缩得到明显改善,拇指可完成外展及对掌功能,握力较健侧略差,可完成日常生活及部分工作,但部分皮瓣感觉欠佳.移植皮瓣外形:超薄型髂腹股沟皮瓣外形良好,3例血管蒂逆行岛状皮瓣、1例神经营养血管蒂皮瓣及2例游离皮瓣术后再次行皮瓣修整术以改善皮瓣外形.结论重度虎口挛缩可应用不同类型皮瓣予以治疗,应根据具体情况选择合适的治疗方式.
목적 총결궤충피판이식술치료중도호구련축적효과.방법 침대2000년9월지2009년3월수치적중도호구련축적32례병례,응용초박형가복고구피판、혈관체역행도상피판、신경영양혈관체피판급유리피판여이치료,피판면적3.0 cm×5.0 cm～4.5 cm×8.0 cm,술후수방3～12개월,관찰기치료결과.결과 1례신경영양혈관체피판화1례초박형가복고구피판원단부분배사,후경유리식피술창면유합,기여피판균완전성활,부분병례술후탁제극씨침고정후호구유부분정도회축,호구각평균위70°(45°～80°),호구관도평균위50 mm(35～60 mm),위건측적80%,련축득도명현개선,무지가완성외전급대장공능,악력교건측략차,가완성일상생활급부분공작,단부분피판감각흠가.이식피판외형:초박형가복고구피판외형량호,3례혈관체역행도상피판、1례신경영양혈관체피판급2례유리피판술후재차행피판수정술이개선피판외형.결론 중도호구련축가응용불동류형피판여이치료,응근거구체정황선택합괄적치료방식.
Objective To summarize the result of several kinds of flaps treated to first web space contraction. Methods Thirty-two cases of sever contracture of the first web space were treated between September 2000 and March 2009. Ultrathin groin flap, blood vessel pedicle reverse-flow island flap, neurocutaneous flap of the forearm, and free skin flap were used. The area of flaps were 3.0 cm × 5.0 cm-4.5 cm× 8.0 cm.The therapeutic result was observed by 3-12 months follow-up. Results There were partial necrosis at the distal part of flap in 1 case of nerve nutritional vascular pedicle skin flap and 1 case of ultrathin groin flap.The raw surface was healed by free skin grafting. The other flaps were all survived. There was some contraction observed in some patients after the K-wire released. The width of the first web space was augmented to an average of 50 mm (35-60 mm) and account to 80% to the uninjured side. The angle of the first web space was increased to an average of 70°(45°-80°). The contracture was improved significantly. The abduction and opposition function of thumb were restored. There was some degree decrease of grasp strength. The patients can fulfil daily life and partial work. But sensation was not good in some patients. The contour of the flaps:the contour of ultrathin groin flap was good. The contour of flaps in 3 cases of island skin flaps, 1 case of nerve nutritional vascular pedicle skin flap and 2 cases of free flaps were trimmed again in order to be improved. Conclusion The sever contracture of the first web space could be treated by different kinds of flaps, the suitable management should be chosen according to the specific situation.