中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2013年
1期
24-27
,共4页
股前外侧皮瓣%异体肌腱%手背%显微外科
股前外側皮瓣%異體肌腱%手揹%顯微外科
고전외측피판%이체기건%수배%현미외과
Anterolateral thigh flap%Tendon allograft%Dorsal hand%Microsurgery
目的 评价同种异体肌腱加皮瓣对手背复合软组织缺损一期修复重建的临床疗效. 方法 2006年7月至2011年7月,对15例手背复合软组织缺损患者一期采用股前外侧皮瓣联合同种异体肌腱行手背伸肌腱修复和创面覆盖,皮瓣大小9 cm×5 cm ～ 14 cm×11 cm,每例修复手背肌腱缺损2～4条,术后2周皮瓣成活后利用被动伸指支具进行早期康复训练. 结果 15例皮瓣均成活,12例患者术后获得随访12 ～ 24个月,平均16个月.2例患者因肌腱粘连术后6个月行肌腱松解,其余10例患者手指屈伸良好.随访结束时,患手腕关节主动屈40°～ 70°,伸25°～50°,掌指关节60°～85°、指间关节80°～90°活动范围,总体优良率达92％. 结论 一期同种异体肌腱联合皮瓣修复手背皮肤及伸指肌腱缺损的方法安全可靠,疗效肯定.同期异体肌腱重建不仅可以避免自体肌腱移植引起的新创伤,而且可以确保及时的手指康复训练,避免了延期手术所致的伸指功能丢失.
目的 評價同種異體肌腱加皮瓣對手揹複閤軟組織缺損一期脩複重建的臨床療效. 方法 2006年7月至2011年7月,對15例手揹複閤軟組織缺損患者一期採用股前外側皮瓣聯閤同種異體肌腱行手揹伸肌腱脩複和創麵覆蓋,皮瓣大小9 cm×5 cm ～ 14 cm×11 cm,每例脩複手揹肌腱缺損2～4條,術後2週皮瓣成活後利用被動伸指支具進行早期康複訓練. 結果 15例皮瓣均成活,12例患者術後穫得隨訪12 ～ 24箇月,平均16箇月.2例患者因肌腱粘連術後6箇月行肌腱鬆解,其餘10例患者手指屈伸良好.隨訪結束時,患手腕關節主動屈40°～ 70°,伸25°～50°,掌指關節60°～85°、指間關節80°～90°活動範圍,總體優良率達92％. 結論 一期同種異體肌腱聯閤皮瓣脩複手揹皮膚及伸指肌腱缺損的方法安全可靠,療效肯定.同期異體肌腱重建不僅可以避免自體肌腱移植引起的新創傷,而且可以確保及時的手指康複訓練,避免瞭延期手術所緻的伸指功能丟失.
목적 평개동충이체기건가피판대수배복합연조직결손일기수복중건적림상료효. 방법 2006년7월지2011년7월,대15례수배복합연조직결손환자일기채용고전외측피판연합동충이체기건행수배신기건수복화창면복개,피판대소9 cm×5 cm ～ 14 cm×11 cm,매례수복수배기건결손2～4조,술후2주피판성활후이용피동신지지구진행조기강복훈련. 결과 15례피판균성활,12례환자술후획득수방12 ～ 24개월,평균16개월.2례환자인기건점련술후6개월행기건송해,기여10례환자수지굴신량호.수방결속시,환수완관절주동굴40°～ 70°,신25°～50°,장지관절60°～85°、지간관절80°～90°활동범위,총체우량솔체92％. 결론 일기동충이체기건연합피판수복수배피부급신지기건결손적방법안전가고,료효긍정.동기이체기건중건불부가이피면자체기건이식인기적신창상,이차가이학보급시적수지강복훈련,피면료연기수술소치적신지공능주실.
Objectives To evaluate the clinical effect of one-stage reconstruction of dorsal hand softtissue defects using tendon allograft and free anterolateral thigh flaps.Methods From July 2006 to July 2011,fifteen cases of complex soft-tissue defects in dorsal hands were repaired using tendon allografts and anterolateral thigh flaps,sizing from 9 cm ×5 cm to 14 cm× 11 cm,in one stage.Two to 4 digital extensor tendons were reconstructed.With a brace on,early finger exercises were started after 2 weeks postoperatively when the flaps had survived.Results All the 15 flaps survived uneventfully.Twelve of the 15 patients were available for follow-up from 12-24 months (averaged 16 months).Two cases received tendolysis due to poor finger movement 6 moths postoperatively.At the end of follow-up,the range of wrist joint active flexion is from 40 to 70degrees and extension is from 25 to 50 degrees.The motion range of the related metacarpophalangeal joints was from 60 to 85 degrees,that of the interphalangeal joints from 80 to 90 degrees.The overall effective rate was 92 percent.Conclusion Simultaneous composite repair using tendon allografts and skin flaps proved to be reliable and cost-effective for complex dorsal hand soft-tissue defects.Allograft tendon reconstruction can not only obliterates new morbidities of autografting but also facilitates timely rehabilitation,avoiding extension loss of hand joints.
