邻指皮瓣与腹部皮瓣修复指腹皮肤软组织缺损的临床效果对比
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摘要
目的探讨修复指腹皮肤软组织缺损中使用邻指皮瓣和腹部皮瓣的效果和临床价值。方法选取本院2015年11月~2017年11月指腹皮肤软组织缺损患者80例,根据入院先后将其均分为两组,每组40例,1组为对照组,使用腹部皮瓣方法修复;2组为观察组,使用邻指皮瓣方法修复。比较两组患者手术时间、住院时间、关节活动度、不良反应情况和总有效率。结果治疗前,两组患者关节活动度无差异(P>0.05);治疗后,观察组手术时间、住院时间和关节活动度明显优于对照组(P<0.05)。观察组和对照组不良反应发生率依次为10.00%和22.50%,观察组明显低于对照组(P<0.05)。观察组和对照组总有效率依次为97.50%和85.00%,观察组总有效率明显高于对照组(P<0.05)。结论在修复指腹皮肤组织缺损时使用邻指皮瓣能进一步缩短手术时间和住院时间,对提高患者关节活动度有明显帮助,且该方法修复状况较好,整体治疗率较高,可在各大医院中推广使用。
Objective To discuss the specific effects and clinical values of the application of cross finger flap and abdominal flap in the repair of soft tissue defects of finger pulp. Methods A total of 80 patients with soft tissue defects of finger pulp in our hospital from November 2015 to November 2017 were selected. According to the admission order,they were divided into two groups, with 40 cases in each group. Group one was the control group and was given abdominal flap for repair. Group two was the observation group and was given cross finger flap for repair. The operation time,length of hospital stay, joint mobility, adverse reactions and total effective rate were compared between the two groups.Results Before treatment, there was no difference in joint mobility between the two groups(P>0.05); after treatment, the operation time, length of stay, and joint mobility in the observation group were significantly better than those in the control group(P<0.05). The incidence rate of adverse reactions in the observation group and control group was 10.00%and 22.50% respectively. The observation group was significantly lower than the control group(P<0.05). The total effective rate in the observation group and the control group was 97.50% and 85.00% respectively. The total effective rate in the observation group was significantly higher than that in the control group(P<0.05). Conclusion The application of cross finger flap in the repair of soft tissue defects of finger pulp can further reduce the operation time and length of stay, which is significantly helpful to improve the joint mobility of the patients. This method has a good repair effect,and the overall treatment efficiency is high. It can be promoted and applied in major hospitals.
Objective To discuss the specific effects and clinical values of the application of cross finger flap and abdominal flap in the repair of soft tissue defects of finger pulp. Methods A total of 80 patients with soft tissue defects of finger pulp in our hospital from November 2015 to November 2017 were selected. According to the admission order,they were divided into two groups, with 40 cases in each group. Group one was the control group and was given abdominal flap for repair. Group two was the observation group and was given cross finger flap for repair. The operation time,length of hospital stay, joint mobility, adverse reactions and total effective rate were compared between the two groups.Results Before treatment, there was no difference in joint mobility between the two groups(P>0.05); after treatment, the operation time, length of stay, and joint mobility in the observation group were significantly better than those in the control group(P<0.05). The incidence rate of adverse reactions in the observation group and control group was 10.00%and 22.50% respectively. The observation group was significantly lower than the control group(P<0.05). The total effective rate in the observation group and the control group was 97.50% and 85.00% respectively. The total effective rate in the observation group was significantly higher than that in the control group(P<0.05). Conclusion The application of cross finger flap in the repair of soft tissue defects of finger pulp can further reduce the operation time and length of stay, which is significantly helpful to improve the joint mobility of the patients. This method has a good repair effect,and the overall treatment efficiency is high. It can be promoted and applied in major hospitals.
引文
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[11]李国强,焦延杰,王夫平,等.第一趾蹼皮瓣修复单指中末节脱套伤或伴指蹼缺损的邻指掌侧皮肤缺损[J].中华显微外科杂志,2017,40(5):483-485.
[12]Dagtekin O,Hotz A,Kampe S,et al.Postoperative analgesia and flap perfusion after pedicled TRAM flap reconstruction-continuous wound instillation with ropivacaine 0.2%.A pilot study[J].Journal of Plastic,Reconstructive&Amp;Aesthetic Surgery:JPRAS,2009,62(5):618-625.
[13]赵风景,张兴群,李宏烨,等.腕横纹桡动脉掌浅支皮瓣修复手指软组织缺损[J].中华整形外科杂志,2016,32(6):468-469.
[14]Steiert AE,Gohritz A,Schreiber TC,et al.Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure(VAC)therapy-worse or worth?[J].Journal of Plastic,Reconstructive&Amp;Aesthetic Surgery:JPRAS,2009,62(5):675-683.
[15]方柏荣,孙杨,熊祥,等.腹壁下动脉穿支血管构造在腹壁下动脉穿支皮瓣修薄中的应用[J].中华整形外科杂志,2017,33(1):16-20.
[16]赵浩呈,赵焕丽.腹部带蒂皮瓣及邻指皮瓣移植法修复示指末节缺损伴指骨外露疗效分析[J].现代医药卫生,2017,33(22):3450-3452.
[17]巨积辉,金光哲,徐磊,等.套脱皮肤原位再植结合腹部分指套状皮瓣修复全手皮肤套脱伤[J].中华手外科杂志,2016,32(6):417-419.
[18]李建宁,巨积辉,王强,等.(足母)甲皮瓣与第二趾胫侧皮瓣瓦合修复拇指末节套脱伤[J].中华手外科杂志,2013,29(1):34-36.
[19]靳兆印,张敬良,陈雷,等.尺动脉腕上皮支上行支皮瓣游离移植修复手指末节软组织缺损[J].中华手外科杂志,2015,31(1):47-49.
[20]叶永志,张隆英,钟永翔,等.改良游离腕横纹皮瓣在手指指腹皮肤缺损修复中的应用[J].中国骨与关节损伤杂志,2016,31(11):1223-1224.
[2]李晓亮,谭桂豫,巩凡,等.邻指皮瓣与腹部带蒂皮瓣修复指背皮肤缺损的临床疗效分析[J].宁夏医学杂志,2016,38(8):683-685.
[3]Karakayali F,Karagulle E,Karabulut Z,et al.Unroofing and marsupialization vs rhomboid excision and Limberg flap in pilonidal disease:A prospective,randomized,clinical trial[J].Diseases of the Colon and Rectum,2009,52(3):496-502.
[4]张华义.带血管蒂邻指皮瓣修复术治疗手指末节皮肤脱套伤的临床疗效观察[J].实用中西医结合临床,2016,16(6):24-25.
[5]蔡若赋,周杰,党书汉,等.超微型皮瓣在修复手指指端及指腹皮肤缺损中的应用[J].中华手外科杂志,2013,29(5):276.
[6]瞿刚,全仁夫,侯桥,等.指动脉皮瓣桥式交叉转移修复邻指难愈性创面11例[J].中华显微外科杂志,2015,38(5):497-499.
[7]刘刚义,付清海,朱修文,等.指动脉串或并联岛状皮瓣修复指端脱套伤[J].中华显微外科杂志,2014,37(3):225-228.
[8]白辉凯,谢振军,赵国红,等.示指桡背侧皮神经营养血管皮瓣修复示指指端皮肤软组织缺损[J].中华手外科杂志,2014,30(4):319.
[9]王健.邻指皮瓣修复指腹软组织缺损50例[J].中国冶金工业医学杂志,2016,33(1):28-29.
[10]Dai P,Jeong SY,Yu Y,et al.Modulation of TLR signaling by multiple My D88-interacting partners including leucine-rich repeat Fli-I-interacting proteins[J].The Journal of Immunology:Official Journal of the American Association of Immunologists,2009,182(6):3450-3460.
[11]李国强,焦延杰,王夫平,等.第一趾蹼皮瓣修复单指中末节脱套伤或伴指蹼缺损的邻指掌侧皮肤缺损[J].中华显微外科杂志,2017,40(5):483-485.
[12]Dagtekin O,Hotz A,Kampe S,et al.Postoperative analgesia and flap perfusion after pedicled TRAM flap reconstruction-continuous wound instillation with ropivacaine 0.2%.A pilot study[J].Journal of Plastic,Reconstructive&Amp;Aesthetic Surgery:JPRAS,2009,62(5):618-625.
[13]赵风景,张兴群,李宏烨,等.腕横纹桡动脉掌浅支皮瓣修复手指软组织缺损[J].中华整形外科杂志,2016,32(6):468-469.
[14]Steiert AE,Gohritz A,Schreiber TC,et al.Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure(VAC)therapy-worse or worth?[J].Journal of Plastic,Reconstructive&Amp;Aesthetic Surgery:JPRAS,2009,62(5):675-683.
[15]方柏荣,孙杨,熊祥,等.腹壁下动脉穿支血管构造在腹壁下动脉穿支皮瓣修薄中的应用[J].中华整形外科杂志,2017,33(1):16-20.
[16]赵浩呈,赵焕丽.腹部带蒂皮瓣及邻指皮瓣移植法修复示指末节缺损伴指骨外露疗效分析[J].现代医药卫生,2017,33(22):3450-3452.
[17]巨积辉,金光哲,徐磊,等.套脱皮肤原位再植结合腹部分指套状皮瓣修复全手皮肤套脱伤[J].中华手外科杂志,2016,32(6):417-419.
[18]李建宁,巨积辉,王强,等.(足母)甲皮瓣与第二趾胫侧皮瓣瓦合修复拇指末节套脱伤[J].中华手外科杂志,2013,29(1):34-36.
[19]靳兆印,张敬良,陈雷,等.尺动脉腕上皮支上行支皮瓣游离移植修复手指末节软组织缺损[J].中华手外科杂志,2015,31(1):47-49.
[20]叶永志,张隆英,钟永翔,等.改良游离腕横纹皮瓣在手指指腹皮肤缺损修复中的应用[J].中国骨与关节损伤杂志,2016,31(11):1223-1224.