CAJ | 학술논문

目的：探讨应用足背分叶皮瓣携带趾伸肌腱移植同期修复多手指皮肤合并肌腱组织缺损的临床效果。方法2011年5月～2013年10月治疗12例（27指）多手指皮肤合并伸、屈肌腱缺损患者。根据伤指创面大小、形状设计以足背血管为主干的跗内侧、第一跖背、跗外侧血管为分支构成的足内侧、第1跖背、足外侧三叶或以第一跖背、跗外侧血管为分支构成的第1跖背、足外侧双叶皮瓣移植，切取皮瓣同时携带趾伸肌腱，一次性修复2～3指的皮肤合并1指或2指的屈、伸肌腱缺损。结果移植皮瓣全部成活。其中3例发生动脉危象，2例经静脉使用抗血管痉挛药物后皮瓣成活，1例经血管探查，切除血栓段血管，重新吻合动脉后皮瓣成活。12例经8～19个月随访，皮瓣外形和质地良好，18指屈伸功能正常，5指屈曲轻度受限，伸直正常，4指屈曲有较明显受限，伸直轻微受限。供皮瓣和肌腱足无明显瘢痕挛缩，行走正常。结论应用足背分叶皮瓣携带趾伸肌腱游离移植方法，一次手术能修复多个手指皮肤合并肌腱缺损，皮瓣外形和质地良好，手指获得良好的功能恢复，是修复多手指皮肤合并腱肌组织缺损的有效方法。
목적：탐토응용족배분협피판휴대지신기건이식동기수복다수지피부합병기건조직결손적림상효과。방법2011년5월～2013년10월치료12례（27지）다수지피부합병신、굴기건결손환자。근거상지창면대소、형상설계이족배혈관위주간적부내측、제일척배、부외측혈관위분지구성적족내측、제1척배、족외측삼협혹이제일척배、부외측혈관위분지구성적제1척배、족외측쌍협피판이식，절취피판동시휴대지신기건，일차성수복2～3지적피부합병1지혹2지적굴、신기건결손。결과이식피판전부성활。기중3례발생동맥위상，2례경정맥사용항혈관경련약물후피판성활，1례경혈관탐사，절제혈전단혈관，중신문합동맥후피판성활。12례경8～19개월수방，피판외형화질지량호，18지굴신공능정상，5지굴곡경도수한，신직정상，4지굴곡유교명현수한，신직경미수한。공피판화기건족무명현반흔련축，행주정상。결론응용족배분협피판휴대지신기건유리이식방법，일차수술능수복다개수지피부합병기건결손，피판외형화질지량호，수지획득량호적공능회복，시수복다수지피부합병건기조직결손적유효방법。
Objective To investigate the clinical effect of dorsal lobulated flap with toe extensor tendon grafting in the repair of finger skin combined with tendon tissue defect.Methods Twelve patients (27 fingers) with multi-finger skin stretch and flexor tendon defect were admitted in our department from May 2011 to Oct.2013.According to the size and shape of the wounds,transplantation of medial foot flap,the first dorsal metatarsal flap and three-leaf flap of lateral foot were applied with the dorsal vessel designed as the backbone and medial tarsal vessel, the first dorsal metatarsal vessel and lateral vessel as the branch;or transplantation of the first dorsal metatarsal flap and double-leaf flap of lateral foot were applied with the first dorsal metatarsal vessel and lateral vessel as the branch.Flap with toe extensor tendon was cut for one-time repair of the skin defect associated with flexor and exten-sor tendon defects in 1 or 2 fingers.Results All transplanted flaps survived.Arterial crisis occurred in 3 cases, and 2 of them survived by treatment with intravenous anti-vascular spasm drugs,and the other survived by vascular exploration,excision of vascular segment and re-anastomosis of artery flap.All cases were followed up for 8-19 months.Their flap and texture were good.The flexion function was normal in 18 fingers,slightly restricted in 5 and obviously limited in 4.For skin and tendon of the donor foot,obvious scar contracture was not found and walking function was normal in all the patients.Conclusion Dorsal lobulated flap with toe extensor tendon grafting in the repair of finger skin combined with tendon tissue defect can achieve good looking and functional recovery.It is good for the repair of finger skin combined with tendon tissue defect.