中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2012年
3期
186-188,后插7
,共4页
潘希贵%管同勋%李亮%朱哲%王作锋
潘希貴%管同勛%李亮%硃哲%王作鋒
반희귀%관동훈%리량%주철%왕작봉
前臂%腕部%负压封闭引流%外科皮瓣
前臂%腕部%負壓封閉引流%外科皮瓣
전비%완부%부압봉폐인류%외과피판
Forearm%Wrist%Vaccum sealing drainag%Surgical flap
目的 探讨前臂掌侧及腕部复杂性损伤分期救治的疗效. 方法 自2008年3月至2011年12月,对前臂掌侧及腕部大范围皮肤缺损合并屈肌腱和尺、桡动脉及正中和尺神经断裂及缺损11例,部分合并有尺、桡骨骨折的患者,在急诊清创、血管、神经及屈肌腱修复及骨折固定后,创面应用VSD覆盖;二期修复在去除VSD后,正中和尺神经缺损采用腓肠神经移植修复,创面应用游离皮瓣或复合组织瓣结合游离植皮修复. 结果 VSD治疗后11例创面感染均得到良好控制,肉芽组织覆盖大部分肌腱;细菌培养结果均为阴性,去除VSD敷料后见创面明显缩小,经游离植皮和组织瓣转移修复创面,均获成功.经3个月～3年(平均13个月)的随访,有3例于伤后1年行腕部屈肌腱粘连松解术,骨支架愈合良好,皮瓣血运、质地、弹性良好.手部血运好,损伤神经感觉恢复至S3以上,手内在肌的功能均有不同程度的恢复. 结论 采用急诊清创、组织修复后应用VSD治疗,二期游离皮瓣或复合组织瓣修复分期治疗方法对臂掌侧及腕部严重复合组织缺损进行修复效果好,是一种良好的手术选择.
目的 探討前臂掌側及腕部複雜性損傷分期救治的療效. 方法 自2008年3月至2011年12月,對前臂掌側及腕部大範圍皮膚缺損閤併屈肌腱和呎、橈動脈及正中和呎神經斷裂及缺損11例,部分閤併有呎、橈骨骨摺的患者,在急診清創、血管、神經及屈肌腱脩複及骨摺固定後,創麵應用VSD覆蓋;二期脩複在去除VSD後,正中和呎神經缺損採用腓腸神經移植脩複,創麵應用遊離皮瓣或複閤組織瓣結閤遊離植皮脩複. 結果 VSD治療後11例創麵感染均得到良好控製,肉芽組織覆蓋大部分肌腱;細菌培養結果均為陰性,去除VSD敷料後見創麵明顯縮小,經遊離植皮和組織瓣轉移脩複創麵,均穫成功.經3箇月～3年(平均13箇月)的隨訪,有3例于傷後1年行腕部屈肌腱粘連鬆解術,骨支架愈閤良好,皮瓣血運、質地、彈性良好.手部血運好,損傷神經感覺恢複至S3以上,手內在肌的功能均有不同程度的恢複. 結論 採用急診清創、組織脩複後應用VSD治療,二期遊離皮瓣或複閤組織瓣脩複分期治療方法對臂掌側及腕部嚴重複閤組織缺損進行脩複效果好,是一種良好的手術選擇.
목적 탐토전비장측급완부복잡성손상분기구치적료효. 방법 자2008년3월지2011년12월,대전비장측급완부대범위피부결손합병굴기건화척、뇨동맥급정중화척신경단렬급결손11례,부분합병유척、뇨골골절적환자,재급진청창、혈관、신경급굴기건수복급골절고정후,창면응용VSD복개;이기수복재거제VSD후,정중화척신경결손채용비장신경이식수복,창면응용유리피판혹복합조직판결합유리식피수복. 결과 VSD치료후11례창면감염균득도량호공제,육아조직복개대부분기건;세균배양결과균위음성,거제VSD부료후견창면명현축소,경유리식피화조직판전이수복창면,균획성공.경3개월～3년(평균13개월)적수방,유3례우상후1년행완부굴기건점련송해술,골지가유합량호,피판혈운、질지、탄성량호.수부혈운호,손상신경감각회복지S3이상,수내재기적공능균유불동정도적회복. 결론 채용급진청창、조직수복후응용VSD치료,이기유리피판혹복합조직판수복분기치료방법대비장측급완부엄중복합조직결손진행수복효과호,시일충량호적수술선택.
Objective To investigate the therapeutic effect of stage treatment of severe complicated injuries in palmar forearm and wrist. Methods From March 2008 to Novemler 2011, eleven cases with skin lost combined with fracture and lost of flexor tendon, ulnar radial arteries, median and ulnar nerves,and some of them had fracture of ulnar and radius were treated in the first stage with vacuum sealing drainage after emergency debridement and tissue repair. Secondary microsurgical repair was performed after the VSD was removed. The lost of median and ulnar nerves was repaired with transplantation of sural nerve,and the wound was repaired with free flaps and complex tissue flaps. Results Eleven cases were treated with vacuum sealing drainage for 7 to 10 days.Infections were under control,wound areas reduced and most wound areas were covered by granulation tissues.Flaps and skin grafts were survived.After postoperative follow-up for 3 to 36 months (average 13 months),three cases was received flexor tendolysis.As result,the blood circulation of hand was good, the sensor of injured nerve was higher than S3, and there was a good functional rehabilitation of hand muscles. Conclusion Using vacuum sealing drainage after emergency debridement and tissue repair, there was a good repairing effect of secondary repair with flaps and skin grafts for severe complicated tissue defect in palmar forearm and wrist,and it is an effective choice of operation.
