足背双叶皮瓣游离移植修复拇指大面积皮肤缺损的临床效果
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摘要
目的分析足背双叶皮瓣游离移植修复拇指大面积皮肤缺损的临床效果。方法 12例拇指皮肤大面积损伤病人,设计用胫前动脉静脉或足背动静脉为蒂,第一跖背、跗外侧足背双叶皮瓣,一次性修复拇指大面积皮肤缺损。观察皮瓣成活情况,创面愈合情况。结果术后11例(91.67%)皮瓣一期成活,1例(8.33%)皮瓣出现血管危象坏死,经换药后二期植皮修复;创面11例(91.67%)一期愈合,其中1例(8.33%)术后第2天出现皮瓣下血肿,导致皮瓣坏死,经二期植皮后愈合;供区足背创面植皮部分坏死1例,经换药治疗后愈合。经4～14个月随访,皮瓣外形肤色恢复良好,两点分辨感觉平均恢复5～8 mm。手指屈伸活动功能满意。结论足背双叶皮瓣游离移植修复拇指大面积皮肤缺损,皮瓣成活率、创面愈合率较高;两个皮瓣共用一套血管,简化手术操作,提高手术成功率;还可以修复受伤拇指的伸缩及感觉功能,能够做到"功能性修复",值得在临床上大力推广。
Objective To analysis of the effect of composite dorsalis pedis free skin flap to repair pollex of large area skin wounds.Methods 12 patients with extensive skin lesions of the thumb and skin were selected.The anterior tibial artery or the dorsal arteries and veins were designed as the pedicle.Leaf flaps,which repair large areas of the thumb with a single defect.Observe the survival of the flap and the healing of the wound.Results 11 cases(91.67%)of the flap survived in the first stage,1 case(8.33%)showed vascular crisis necrosis,and the second stage of skin graft repair after dressing change;11 cases(91.67%)of the wound healed in the first stage.1 case(8.33%)showed subcutaneous flap hematoma on the second day after operation,which led to necrosis of the skin flap and healed after the second stage of skin grafting.1 case of necrosis of the skin graft in the donor site was healed after dressing change.After 4 to 14 months of followed-up,the skin color of the flap recovered well,and the two-point resolution felt an average of 5 to 8 mm.The function of finger flexion and extension is satisfactory.Conclusion The free flap of the dorsal dorsum flap can repair the large area of the skin defect of the thumb.The survival rate of the flap and the wound healing rate are high.The two flaps share a set of blood vessels,simplify the operation and improve the success rate of the operation.The flexion and sensory function of the thumb can achieve "functional repair",which is worthy of promotion in the clinic.
Objective To analysis of the effect of composite dorsalis pedis free skin flap to repair pollex of large area skin wounds.Methods 12 patients with extensive skin lesions of the thumb and skin were selected.The anterior tibial artery or the dorsal arteries and veins were designed as the pedicle.Leaf flaps,which repair large areas of the thumb with a single defect.Observe the survival of the flap and the healing of the wound.Results 11 cases(91.67%)of the flap survived in the first stage,1 case(8.33%)showed vascular crisis necrosis,and the second stage of skin graft repair after dressing change;11 cases(91.67%)of the wound healed in the first stage.1 case(8.33%)showed subcutaneous flap hematoma on the second day after operation,which led to necrosis of the skin flap and healed after the second stage of skin grafting.1 case of necrosis of the skin graft in the donor site was healed after dressing change.After 4 to 14 months of followed-up,the skin color of the flap recovered well,and the two-point resolution felt an average of 5 to 8 mm.The function of finger flexion and extension is satisfactory.Conclusion The free flap of the dorsal dorsum flap can repair the large area of the skin defect of the thumb.The survival rate of the flap and the wound healing rate are high.The two flaps share a set of blood vessels,simplify the operation and improve the success rate of the operation.The flexion and sensory function of the thumb can achieve "functional repair",which is worthy of promotion in the clinic.
引文
[1]郭欣,肖亚东.应用前臂逆行岛状皮瓣及带足背皮瓣第2足趾游离移植再造修复拇指Ⅵ度缺损[J].实用手外科杂志,2014,28(2):230-231.
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[4]杨庆达,卢建国,卢家灵,等.改良第一趾蹼皮瓣游离移植修复拇指和示指皮肤缺损[J].中华显微外科杂志,2013,36(2):179-181.
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[7]陈文雄,谢广中,梅林军,等.应用游离足背并联双叶皮瓣修复单指皮肤脱套伤的临床观察[J].广东医学院学报,2015,16(2):208-210.
[8]Lee JC,Hsu WT,Yang CC,et al.A fabricated forearm free flap with accompanying phonation tube for simultaneous reconstruction of a pharyngolaryngeal circumferential defect and voice loss[J].Laryngoscope,2013,123(2):344-349.
[9]甘干达,唐继全,扈克治,等.应用足背分叶皮瓣携带趾伸肌腱移植修复多手指皮肤合并肌腱组织缺损[J].创伤外科杂志,2015,23(5):410-413.
[10]Yu YD,Zhang YZ,Bi WD,et al.Functional sensory function recovery of random-pattern abdominal skin flap in the repair of fingertip skin defects[J].Exp Ther Med,2013,5(3):830-834.
[11]胡浩良,李学渊,周晓玲,等.个性化设计游离上臂外侧穿支皮瓣修复手部不规则皮肤软组织缺损[J].中国修复重建外科杂志,2015,19(12):1510-1514.
[12]M Romanelli,V Dini.Fractional epidermal skin grafting[J].British Journal of Dermatology,2015,172(4):853-854.
[13]赵玉华,邵文年,申建刚,等.第二足趾与足背三叶皮瓣复合移植修复拇指及手部皮肤缺损的临床研究[J].中华手外科杂志,2014,30(5):193-195.
[14]张全荣,芮永军,许亚军,等.游离足背同蒂多叶皮瓣治疗多指指背皮肤缺损[J].实用手外科杂志,2015,8(1):6-9.
[15]Wang H,Guan ZG,Fang JY,et al.Application of dorsal retrograde fascia flap of hands in the operation of fingers skin and soft tissue defect repairation[J].Chinese Journal of Aesthetic Medicine,2013,18(27):662-668.
[16]王颖,陈筱粼.指动脉背侧支皮瓣修复术后血管危象的早期诊断和护理治疗[J].临床与病理杂志,2015,35(2):230-233.
[2]胡小峰,陈建民,郑晓飞,等.足背双叶皮瓣游离移植修复手部2个手指皮肤缺损[J].中华手外科杂志,2015,31(3):932-934.
[3]Qi JW.Skin defect of the finger repaired with the free flap accompanying with tendon which pedicled on the palmar branch of the supracarpal perforator of ulnar artery[J].Journal of Reconstructive Microsurgery,2014,30(1):482-483.
[4]杨庆达,卢建国,卢家灵,等.改良第一趾蹼皮瓣游离移植修复拇指和示指皮肤缺损[J].中华显微外科杂志,2013,36(2):179-181.
[5]Wu Z,Song D,Lin J,et al.Anatomic basis of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels:a cadaveric dissection[J].Surg Radiol Anat,2015,37(8):975-981.
[6]徐少宏,高伟烨,吕少威,等.跗外侧动脉皮瓣移植修复前足及手部皮肤缺损31例[J].海南医学,2016,27(2):304-305.
[7]陈文雄,谢广中,梅林军,等.应用游离足背并联双叶皮瓣修复单指皮肤脱套伤的临床观察[J].广东医学院学报,2015,16(2):208-210.
[8]Lee JC,Hsu WT,Yang CC,et al.A fabricated forearm free flap with accompanying phonation tube for simultaneous reconstruction of a pharyngolaryngeal circumferential defect and voice loss[J].Laryngoscope,2013,123(2):344-349.
[9]甘干达,唐继全,扈克治,等.应用足背分叶皮瓣携带趾伸肌腱移植修复多手指皮肤合并肌腱组织缺损[J].创伤外科杂志,2015,23(5):410-413.
[10]Yu YD,Zhang YZ,Bi WD,et al.Functional sensory function recovery of random-pattern abdominal skin flap in the repair of fingertip skin defects[J].Exp Ther Med,2013,5(3):830-834.
[11]胡浩良,李学渊,周晓玲,等.个性化设计游离上臂外侧穿支皮瓣修复手部不规则皮肤软组织缺损[J].中国修复重建外科杂志,2015,19(12):1510-1514.
[12]M Romanelli,V Dini.Fractional epidermal skin grafting[J].British Journal of Dermatology,2015,172(4):853-854.
[13]赵玉华,邵文年,申建刚,等.第二足趾与足背三叶皮瓣复合移植修复拇指及手部皮肤缺损的临床研究[J].中华手外科杂志,2014,30(5):193-195.
[14]张全荣,芮永军,许亚军,等.游离足背同蒂多叶皮瓣治疗多指指背皮肤缺损[J].实用手外科杂志,2015,8(1):6-9.
[15]Wang H,Guan ZG,Fang JY,et al.Application of dorsal retrograde fascia flap of hands in the operation of fingers skin and soft tissue defect repairation[J].Chinese Journal of Aesthetic Medicine,2013,18(27):662-668.
[16]王颖,陈筱粼.指动脉背侧支皮瓣修复术后血管危象的早期诊断和护理治疗[J].临床与病理杂志,2015,35(2):230-233.
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