中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
1期
15-18
,共4页
李启朝%崔浩杰%朱广明%张双喜%边朝辉
李啟朝%崔浩傑%硃廣明%張雙喜%邊朝輝
리계조%최호걸%주엄명%장쌍희%변조휘
指%手掌%岛状皮瓣%皮肤缺损
指%手掌%島狀皮瓣%皮膚缺損
지%수장%도상피판%피부결손
Fingers%Metacarpus%Island flaps%Skin defect
目的 探讨第2～5指中远节皮肤缺损伴骨折、肌腱断裂的新的修复方法. 方法 以指固有动脉-指总动脉-指蹼动脉-掌背动脉-掌背动脉皮支为蒂,设计掌背逆行岛状皮瓣.在修复指掌侧皮肤缺损、切取皮瓣时,皮瓣近端沿掌背神经方向做延长口,切取足够长度掌背神经,以便与指固有神经吻合,恢复指腹感觉.2003年6月至2009年3月应用此方法修复24例(26指)伴骨折、肌腱断裂的手指中远节皮肤缺损患者,男17例,女7例；年龄16 ～63岁,平均37岁.掌侧皮肤缺损15例17指,背侧缺损9例9指.合并肌腱缺损2例,切取皮瓣时一并切取一段示指(小指)固有伸肌腱修复. 结果 皮瓣切取面积为3.1 cm×1.6 cm～6.0 cm ×4.0 cm.24例皮瓣全部成活,无一例发生血管危象.22例患者术后获4 ～32个月(平均14个月)随访,2例失访.皮瓣质地、色泽好,外形良好,指腹较饱满,恢复痛温觉,两点辨别觉为5～9 mm,平均7.5 mm,按感觉功能评定标准为S3+～S4.4例发生肌腱粘连,术后3～6个月行松解术,手指功能恢复良好. 结论 以指固有动脉为蒂的掌背逆行岛状皮瓣修复伴骨折、肌腱断裂的手指中远节皮肤缺损,是一种较理想的方法.
目的 探討第2～5指中遠節皮膚缺損伴骨摺、肌腱斷裂的新的脩複方法. 方法 以指固有動脈-指總動脈-指蹼動脈-掌揹動脈-掌揹動脈皮支為蒂,設計掌揹逆行島狀皮瓣.在脩複指掌側皮膚缺損、切取皮瓣時,皮瓣近耑沿掌揹神經方嚮做延長口,切取足夠長度掌揹神經,以便與指固有神經吻閤,恢複指腹感覺.2003年6月至2009年3月應用此方法脩複24例(26指)伴骨摺、肌腱斷裂的手指中遠節皮膚缺損患者,男17例,女7例；年齡16 ～63歲,平均37歲.掌側皮膚缺損15例17指,揹側缺損9例9指.閤併肌腱缺損2例,切取皮瓣時一併切取一段示指(小指)固有伸肌腱脩複. 結果 皮瓣切取麵積為3.1 cm×1.6 cm～6.0 cm ×4.0 cm.24例皮瓣全部成活,無一例髮生血管危象.22例患者術後穫4 ～32箇月(平均14箇月)隨訪,2例失訪.皮瓣質地、色澤好,外形良好,指腹較飽滿,恢複痛溫覺,兩點辨彆覺為5～9 mm,平均7.5 mm,按感覺功能評定標準為S3+～S4.4例髮生肌腱粘連,術後3～6箇月行鬆解術,手指功能恢複良好. 結論 以指固有動脈為蒂的掌揹逆行島狀皮瓣脩複伴骨摺、肌腱斷裂的手指中遠節皮膚缺損,是一種較理想的方法.
목적 탐토제2～5지중원절피부결손반골절、기건단렬적신적수복방법. 방법 이지고유동맥-지총동맥-지복동맥-장배동맥-장배동맥피지위체,설계장배역행도상피판.재수복지장측피부결손、절취피판시,피판근단연장배신경방향주연장구,절취족구장도장배신경,이편여지고유신경문합,회복지복감각.2003년6월지2009년3월응용차방법수복24례(26지)반골절、기건단렬적수지중원절피부결손환자,남17례,녀7례；년령16 ～63세,평균37세.장측피부결손15례17지,배측결손9례9지.합병기건결손2례,절취피판시일병절취일단시지(소지)고유신기건수복. 결과 피판절취면적위3.1 cm×1.6 cm～6.0 cm ×4.0 cm.24례피판전부성활,무일례발생혈관위상.22례환자술후획4 ～32개월(평균14개월)수방,2례실방.피판질지、색택호,외형량호,지복교포만,회복통온각,량점변별각위5～9 mm,평균7.5 mm,안감각공능평정표준위S3+～S4.4례발생기건점련,술후3～6개월행송해술,수지공능회복량호. 결론 이지고유동맥위체적장배역행도상피판수복반골절、기건단렬적수지중원절피부결손,시일충교이상적방법.
objective To explore a new method of repairing skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers. Methods The reversed dorsal metacarpal island flap was designed to be pedicled on the digital proper artery-common digital artery-fingerweb artery-dorsal metacarpal artery-cutaneous branch of dorsal metacarpal artery.In repairing digital palmar skin defects,after the flap was dissected,the proximal incision was extended along the direction of dorsal metacarpal nerve to harvest an enough length of the nerve so that the dorsal metacrppal nerve can be anastomosed with the digital proper nerve to restore the sensation of finger pulp.From the June 2003 to March 2009,the flap was used to repair 26 fingers in 24 patients with middle and distal digital skin defects complicated with fracture and tendon rupture.They were 17 men and 7 women,aged from 16 to 63 years (average,37 years).There were 15 cases of palmar skin defect and 9 cases of dorsal skin defect.In the 2 cases of combined tendon defects,a section of the extensor tendon of index (or little) finger was dissected together with the flap to repair the tendon rupture. Results The areas of the flap ranged from 3.1 cm ×1.6 cm to 6.0 cm × 4.0 cm.The flaps survived in all 24 cases without any vascular crisis.Twenty-two patients obtained an average follow-up of 14 months (from 4 to 32 months) but 2 were lost to the follow-up.The flaps were fine in texture,colour and appearance.The finger pulps appeared full and recovered sensations of pain and temperature.The average two-point discrimination was 7.5 mm (from 5 to 9 mm).Sensory function evaluation revealed an outcome of S3 + ～ S4.Tendon adhesion occurred in 4 cases which recovered digital function following secondary lysis 3 to 6 months postoperation. Conclusion Application of the reversed dorsal metacarpal island flap pedicled on the digital proper artery is a good way to repair skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers.
