CAJ | 학술논문

目的探讨应用臂外侧皮瓣桥接再植复杂性离断拇指的方法和临床效果.方法 2007年6月至2009年12月,对9例损伤严重伴有较大面积皮肤、软组织缺损的离断拇指,应用臂外侧皮瓣桥接再植.以臂外侧皮瓣的桡侧副血管为蒂串联重建皮瓣和断指血供,以上臂后皮神经串联重建皮瓣和断指感觉.皮瓣切取面积为6.5 cm×4.5 cm～ 11.0 cm×6.5 cm,血管神经采用端端吻合法.结果术后皮瓣及再植拇指全部存活,随访时间为5～ 12个月,皮瓣外观及弹性良好,感觉恢复至S3～S4.修复后的拇指长度近似健指,外观良好,按中华医学会手外科学会断指再植功能评定标准评定:优5指,良3指,差1指.结论臂外侧皮瓣血管解剖恒定,管径与拇指血管相匹配,重建感觉满意,是桥接再植复杂性离断拇指的有效方法.
목적 탐토응용비외측피판교접재식복잡성리단무지적방법화림상효과.방법 2007년6월지2009년12월,대9례손상엄중반유교대면적피부、연조직결손적리단무지,응용비외측피판교접재식.이비외측피판적뇨측부혈관위체천련중건피판화단지혈공,이상비후피신경천련중건피판화단지감각.피판절취면적위6.5 cm×4.5 cm～ 11.0 cm×6.5 cm,혈관신경채용단단문합법.결과 술후피판급재식무지전부존활,수방시간위5～ 12개월,피판외관급탄성량호,감각회복지S3～S4.수복후적무지장도근사건지,외관량호,안중화의학회수외과학회단지재식공능평정표준평정:우5지,량3지,차1지.결론 비외측피판혈관해부항정,관경여무지혈관상필배,중건감각만의,시교접재식복잡성리단무지적유효방법.
Objective To explore the surgical method of applying free lateral arm flap in the replantation of complex thumb severance and report the clinical outcomes.Methods From June 2007 to December 2009,9 cases of complex thumb severance with large size skin defect were treated.The lateral arm flap was harvested and applied to bridge the tissue in replantation of complex thumb severance.The radial collateral vessel of the lateral arm flap was used to establish blood supply to the flap and the replanted thumb.The posterior brachial cutaneous nerves were included in the flap and repaired to restore sensation of the flap and the replanted thumb.The sizes of the harvested flaps ranged from 6.5 cmx 4.5 cm to 11.0 cmx 6.5 cm.Blood vessels and nerves were anastomosed in an end-to-end fashion.Results All 9 replanted thumbs and the transplanted lateral arm flaps survived completely.Postoperative follow-up ranged from 5 to 12 months.The overall appearance and texture of the transferred flaps were good.Sensory recovery reached S3 to S4.The length of the replanted thumbs was similar to the healthy side with good appearance.According to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,the results were rated as excellent in 5 cases,good in 3 cases,and poor in 1 case.Conclusion The hteral arm flap based on the radial collateral artery has constant vascular anatomy and the calibre of the vascular pedicle is big enough for anastomosis.When the cutaneous nerve is repaired,sensory recovery is satisfactory.It is an effective procedure in bridge replantation of complex thumb severance with large size skin defect.