CAJ | 학술논문

目的探讨吻合皮神经的足底内侧皮瓣修复手掌皮肤缺损的临疗效.方法回顾性分析2003年6月至2013年1月,采用吻合皮神经的足底内侧皮瓣游离移植修复手掌皮肤缺损23例患者资料,男13例,女10例;年龄18～61岁,平均36岁;右侧16例,左侧7例;皮肤缺损面积3.6 cm×2.8 cm～7.0 cm×5.5 cm.其中单纯皮肤软组织缺损者9例,合并血管、神经损伤者5例,合并肌腱断裂、外露者3例,合并掌骨开放性骨折者6例.伤后8h内急诊手术者15例,清创后于10d内手术者8例.结果术后23例均获得随访,随访时间3～36个月,平均18个月.23例患者皮瓣切取范围为4.6 cm×3.8 cm～8.0 cm×6.5 cm.术后19例伤口一期愈合,愈合时间为7～14 d,皮瓣及植皮完全成活,各指指间关节及掌指关节主动屈伸活动度达正常范围,皮瓣感觉恢复好,完全恢复正常生活及工作,两点区分试验4～8 mm;3例皮瓣基本成活,远端部分坏死,足底供区植皮部分坏死,经清创换药后伤口二期愈合,愈合时间为12～21 d,各指指间关节及掌指关节主动屈伸功能轻度受限,基本恢复正常生活及工作,两点区分试验5～9 mm;1例患者术后第4天皮瓣完全坏死,经采用同侧带蒂腹股沟皮瓣修复后治愈,足底供区植皮成活,各指屈伸功能明显受限.根据顾玉东等手功能改进评定标准进行评价,其中优19例,良3例,可1例;优良率为95.7％(22/23).结论吻合皮神经的足底内侧皮瓣游离移植是修复手掌皮肤缺损的理想皮瓣,具有解剖位置恒定、皮瓣成活率高、术后手功能及外观功能恢复好的优点.
목적 탐토문합피신경적족저내측피판수복수장피부결손적림료효.방법 회고성분석2003년6월지2013년1월,채용문합피신경적족저내측피판유리이식수복수장피부결손23례환자자료,남13례,녀10례;년령18～61세,평균36세;우측16례,좌측7례;피부결손면적3.6 cm×2.8 cm～7.0 cm×5.5 cm.기중단순피부연조직결손자9례,합병혈관、신경손상자5례,합병기건단렬、외로자3례,합병장골개방성골절자6례.상후8h내급진수술자15례,청창후우10d내수술자8례.결과 술후23례균획득수방,수방시간3～36개월,평균18개월.23례환자피판절취범위위4.6 cm×3.8 cm～8.0 cm×6.5 cm.술후19례상구일기유합,유합시간위7～14 d,피판급식피완전성활,각지지간관절급장지관절주동굴신활동도체정상범위,피판감각회복호,완전회복정상생활급공작,량점구분시험4～8 mm;3례피판기본성활,원단부분배사,족저공구식피부분배사,경청창환약후상구이기유합,유합시간위12～21 d,각지지간관절급장지관절주동굴신공능경도수한,기본회복정상생활급공작,량점구분시험5～9 mm;1례환자술후제4천피판완전배사,경채용동측대체복고구피판수복후치유,족저공구식피성활,각지굴신공능명현수한.근거고옥동등수공능개진평정표준진행평개,기중우19례,량3례,가1례;우량솔위95.7％(22/23).결론 문합피신경적족저내측피판유리이식시수복수장피부결손적이상피판,구유해부위치항정、피판성활솔고、술후수공능급외관공능회복호적우점.
Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance.