CAJ | 학술논문

目的探讨修复全拇指皮肤脱套伤新术式及疗效. 方法 9例9指全拇指皮肤脱套伤患者,均为机器导致的损伤,除3例3指指间关节开放、拇长屈、伸肌腱断裂外,其他受伤拇指骨、关节及肌腱相对完整.背侧组织缺损面积为4.8cm×2.9 cm～6.2cm×3.4cm,掌侧缺损面积为4.7 cm×3.2cm～6.1 cm×4.0cm.采用(母)甲皮瓣与对侧足部皮瓣进行修复.(母)甲皮瓣切取面积为5.0cm×3.2cm～6.7 cm×3.9 cm,对侧足部皮瓣为带足背皮瓣的第二趾胫侧皮瓣,切取面积为5.0 cm ×3.5 cm～6.6 cm ×4.5 cm. 结果术后9例9指移植皮瓣全部成活,伤口均Ⅰ期愈合,足部供区植皮均顺利成活.术后随访6 ～ 20个月,平均9个月,拇指指腹饱满,感觉恢复S3～S3+,指甲生长良好,拇指抓捏功能良好,掌指关节伸、屈活动接近正常,6指指间关节活动可,但较正常拇指稍差,3例指间关节破坏已融合.供足活动无明显影响. 结论联合(母)甲皮瓣与对侧带足背皮瓣的第二趾胫侧皮瓣修复全拇指皮肤脱套伤是一种临床疗效好供区损伤小的新术式,值得临床推广使用.
목적 탐토수복전무지피부탈투상신술식급료효. 방법 9례9지전무지피부탈투상환자,균위궤기도치적손상,제3례3지지간관절개방、무장굴、신기건단렬외,기타수상무지골、관절급기건상대완정.배측조직결손면적위4.8cm×2.9 cm～6.2cm×3.4cm,장측결손면적위4.7 cm×3.2cm～6.1 cm×4.0cm.채용(모)갑피판여대측족부피판진행수복.(모)갑피판절취면적위5.0cm×3.2cm～6.7 cm×3.9 cm,대측족부피판위대족배피판적제이지경측피판,절취면적위5.0 cm ×3.5 cm～6.6 cm ×4.5 cm. 결과 술후9례9지이식피판전부성활,상구균Ⅰ기유합,족부공구식피균순리성활.술후수방6 ～ 20개월,평균9개월,무지지복포만,감각회복S3～S3+,지갑생장량호,무지조날공능량호,장지관절신、굴활동접근정상,6지지간관절활동가,단교정상무지초차,3례지간관절파배이융합.공족활동무명현영향. 결론 연합(모)갑피판여대측대족배피판적제이지경측피판수복전무지피부탈투상시일충림상료효호공구손상소적신술식,치득림상추엄사용.
Objective To explore the new operation method and clinical effect of treating degloving injuries of the whole thumb.Methods Nine cases of the whole thumb degloving injury caused by machine were treated with free wrap-around flap from the big toe and the flap from the opposite foot.The phalanges,joints and tendons of all injured thumbs were integral relatively,except that the interphalangeal joints in 3 cases were destroyed and the flexor and extensor pollicis longus were ruptured.The size of the dorsal tissue defects varied from 4.8 cm × 2.9 cm to 6.2 cm × 3.4 cm,and the volar tissue defects ranged from 4.7 cm × 3.2 cm to 6.1 cm × 4.0 cm.The area of the wraparound flap from the big toe harvested was from 5.0 cm × 3.2 cm to 6.7 cm × 3.9 cm.The flap from the opposite foot was tibial flap with dorsalis pedis flap from the opposite second toe,and the area of the flap was from 5.0 cm × 3.5 cm to 6.6 cm × 4.5 cm.Results All 9 combined flaps survived.The wound healed primarily.Skin grafts in the donor sites of the foot also survived.Postoperative follow-up ranged from 6 to 20 months,with an everage of 9 months.The pulp of the thumb was well-stacked.Sensory recovery ranged from S3 to S3 +.Thumb nail grew well.Thumbs performed good functions as grabbing,grasping and nipping.The range of motion of the MP joints of the reconstructed thumb was normal.The motion of interphalangeal joints were acceptable in 6 cases,but worse than the normal thumb.The interphalangeal joint in 3 cases destroyed was fused.There was no obvious influence on the function of the foot.Conclusion Applying combined wrap-around flap from the big toe with the tibial flap and dorsalis pedis flap from the opposite foot in treating degloving injuries of the whole thumb is a new operation method,which could achieve good appearance and function,but have a small influence on the donor site.It is worthy being used widely in clinical.