序贯邻指皮瓣联合鱼际皮瓣修复陈旧性多手指指尖软组织缺损
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摘要
目的探讨修复陈旧性多手指指尖软组织缺损的手术治疗方法。方法 2012年1月—2017年6月,滨州医学院烟台附属医院应用序贯邻指皮瓣联合鱼际皮瓣修复受伤时间2周以上的陈旧性多手指指尖软组织缺损的12例患者,其中男性8例,女性4例;年龄35~56岁,平均47.3岁。致伤原因:电锯伤5例,重物压伤4例,撕脱伤2例,冻伤1例。所有患者均有不同程度多个手指(2个手指以上,拇指除外)的指尖软组织缺损,缺损范围为0.5cm×1.3cm~1.4cm×2.3cm。术前所有患者X线检查示存在不同程度的多个手指指尖软组织或骨质的缺损,根据皮肤软组织缺损的大小,在大鱼际处及邻指指背部设计并切取皮瓣,靠近大鱼际的受伤手指行鱼际皮瓣修复。术后定期对12例患者进行随访,观察患者皮瓣的外观、功能、感觉及存活情况。结果 12例移植皮瓣均成活,伤口均I期愈合。对12例患者采用电话随访和门诊复查随访的方式,随访3个月~2年,平均随访时间1.4年。12例患者移植皮瓣完全覆盖缺损,未见坏死、磨损及破溃发生,未出现切口瘢痕挛缩,感觉功能有一定程度的恢复,患者对于移植的皮瓣感到满意。结论序贯邻指皮瓣联合鱼际皮瓣修复陈旧性多手指指尖软组织缺损是一种可行的方法,具有操作简单、外形美观,保留了手指的长度,无需显微外科技术、存活率高及功能良好的优点。
Objective To explore the surgical treatment of the old multiple fingertip soft tissue defects.Methods From Jan. 2012 to Jun. 2017,the materials were collected from the clinical application of sequential adjacent finger flap combined with thenar flap to repair 12 patients with old multiple fingertip soft tissue defects in Yantai Affiliated Hospital of Binzhou Medical University. Among them,there were 8 male patients and 4 female patients. Their age was from 35 to 56,with an average age of 47. 3. Causes of injury included 5 cases of electric saw injury,4 cases of heavy crush injury,2 cases of avulsion injury,and 1 case of frostbite. All of them suffered from the fingertip soft tissue defects of multiple fingers( more than 2 fingers,except thumb) in different degrees. The defect range was 0. 5 × 1. 3 cm-1. 4 × 2. 3 cm. The X-ray examination of all patients before operation showed that there were various defects of the fingertip soft tissue or bone in different degrees. According to the size of the skin soft tissue defect,the skin flap was designed and the flap at greater thenar site was cut for repair,and the adjacent injured fingers were repaired with thenar flap. After operation,12 patients were followed up regularly to observe the appearance,function,sensation and survival of the flaps. Results The flaps of 12 cases all survived after operation,and all wounds acquired primary healing. The patients were followed up for 3 months to 2 years by means of clinical reexamination and telephone,with an average follow-up of 1. 4 years. The transplanted skin flaps had completely covered the defect. No necrosis,abrasion or ulceration occurred,neither did scar contracture. Besides,the sensory function had recovered to some extent. The patients were satisfied with the transplanted flaps. Conclusion It is a feasible method that the sequential adjacent finger flap combined with thenar flap repair old multiple fingertip soft tissue defects,which has the advantages of simple operation,beautiful appearance,retaining the finger length,no need for microsurgical technique,high survival rate and good function.
Objective To explore the surgical treatment of the old multiple fingertip soft tissue defects.Methods From Jan. 2012 to Jun. 2017,the materials were collected from the clinical application of sequential adjacent finger flap combined with thenar flap to repair 12 patients with old multiple fingertip soft tissue defects in Yantai Affiliated Hospital of Binzhou Medical University. Among them,there were 8 male patients and 4 female patients. Their age was from 35 to 56,with an average age of 47. 3. Causes of injury included 5 cases of electric saw injury,4 cases of heavy crush injury,2 cases of avulsion injury,and 1 case of frostbite. All of them suffered from the fingertip soft tissue defects of multiple fingers( more than 2 fingers,except thumb) in different degrees. The defect range was 0. 5 × 1. 3 cm-1. 4 × 2. 3 cm. The X-ray examination of all patients before operation showed that there were various defects of the fingertip soft tissue or bone in different degrees. According to the size of the skin soft tissue defect,the skin flap was designed and the flap at greater thenar site was cut for repair,and the adjacent injured fingers were repaired with thenar flap. After operation,12 patients were followed up regularly to observe the appearance,function,sensation and survival of the flaps. Results The flaps of 12 cases all survived after operation,and all wounds acquired primary healing. The patients were followed up for 3 months to 2 years by means of clinical reexamination and telephone,with an average follow-up of 1. 4 years. The transplanted skin flaps had completely covered the defect. No necrosis,abrasion or ulceration occurred,neither did scar contracture. Besides,the sensory function had recovered to some extent. The patients were satisfied with the transplanted flaps. Conclusion It is a feasible method that the sequential adjacent finger flap combined with thenar flap repair old multiple fingertip soft tissue defects,which has the advantages of simple operation,beautiful appearance,retaining the finger length,no need for microsurgical technique,high survival rate and good function.
引文
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[6]王志浩,丛海波.邻指皮瓣临床应用进展[J].实用手外科杂志,2013,27(4):392-396.
[7]王欣,张世民,俞光荣,等.鱼际皮瓣修复环指指尖缺损[J].中华手外科杂志,2012,28(3):136-137.
[8]侯桥,曾林如,王利祥,等.V-Y推进皮瓣蒂部植皮修复指尖缺损[J].中华手外科杂志,2012,28(3):134-135.
[9]Chen C,Tang P,Zhang L.Reconstruction of a large soft-tissue defect in the single finger using the modified cross-finger flap[J].J Plast Reconstr Aesthet Surg,2015,68(7):990-994.
[10]Lee SH,An SJ,Kim DH,et al.Modified innervated sensory cross-finger flap in failed finger replantation[J].J Hand Surg Eur Vol,2017,42(5):529-530.
[11]Rabarin F,Saint Cast Y,Jeudy J,et al.Cross-finger flap for reconstruction of fingertip amputations:Long-term results[J].Orthop Traumatol Surg Res,2016,102(4):S225-228.
[12]赵国艺,颜海波.邻指皮瓣修复拇指食指指端缺损320例分析[J].创伤外科杂志,2007,9(1):71.
[13]Patil RK,Chavre S.Distally based cross-finger flaps for amputation stumps in avulsion amputations[J].Indian J Plast Surg,2012,45(3):504-511.
[14]Jeon BJ,Yang JW,Roh SY,et al.Microsurgical reconstruction of soft-tissue defects in digits[J].Injury,2013,44(3):356-360.
[15]崔满意,王培吉,田恒进,等.邻指皮瓣缺血训练早期断蒂的临床治疗的体会[J].中华手外科杂志,2016,32(5):396.
[2]Atasoy E.The reverse cross finger flap[J].J Hand Surg(Am),2016,41(1):122-128.
[3]齐巍,于俊,张云鹏,等.以指固有动脉背侧支为蒂的邻指皮瓣修复指掌侧软组织缺损[J].中华整形外科杂志,2014,30(4):300-301.
[4]Nagasao T,Kurihara K,Shimizu Y,et al.Combined usage of hydroxyapatite and cross-finger flap for fiingertip reconstruction[J].J Plast Surg Hand Surg,2014,48(3):205-208.
[5]张文龙,王增涛,李瑞国,等.改良邻指皮瓣在指腹感觉重建中的应用[J].中华整形外科杂志,2013,29(6):461-462.
[6]王志浩,丛海波.邻指皮瓣临床应用进展[J].实用手外科杂志,2013,27(4):392-396.
[7]王欣,张世民,俞光荣,等.鱼际皮瓣修复环指指尖缺损[J].中华手外科杂志,2012,28(3):136-137.
[8]侯桥,曾林如,王利祥,等.V-Y推进皮瓣蒂部植皮修复指尖缺损[J].中华手外科杂志,2012,28(3):134-135.
[9]Chen C,Tang P,Zhang L.Reconstruction of a large soft-tissue defect in the single finger using the modified cross-finger flap[J].J Plast Reconstr Aesthet Surg,2015,68(7):990-994.
[10]Lee SH,An SJ,Kim DH,et al.Modified innervated sensory cross-finger flap in failed finger replantation[J].J Hand Surg Eur Vol,2017,42(5):529-530.
[11]Rabarin F,Saint Cast Y,Jeudy J,et al.Cross-finger flap for reconstruction of fingertip amputations:Long-term results[J].Orthop Traumatol Surg Res,2016,102(4):S225-228.
[12]赵国艺,颜海波.邻指皮瓣修复拇指食指指端缺损320例分析[J].创伤外科杂志,2007,9(1):71.
[13]Patil RK,Chavre S.Distally based cross-finger flaps for amputation stumps in avulsion amputations[J].Indian J Plast Surg,2012,45(3):504-511.
[14]Jeon BJ,Yang JW,Roh SY,et al.Microsurgical reconstruction of soft-tissue defects in digits[J].Injury,2013,44(3):356-360.
[15]崔满意,王培吉,田恒进,等.邻指皮瓣缺血训练早期断蒂的临床治疗的体会[J].中华手外科杂志,2016,32(5):396.