Search

第二趾趾腹菱形皮瓣移位改形法一期再造手指

目的 介绍第2趾趾腹菱形皮瓣移位改形法一期再造手指的方法。方法 2002年9月~2006年10月，在传统方法切取第2趾后，根据趾指腹周径的差值设计趾腹菱形皮瓣，切取血管蒂皮瓣逆转180°将其嵌入第2趾跖侧最狭窄处，一期修整指腹膨大，消除颈部狭窄畸形。应用7例7指，男4例，女3例；年龄18～38岁。损伤原因：机械挤压伤5例，重物砸伤2例。无再植条件，无其他并发症，患指缺损范围Ⅲ～Ⅴ度，截指后于急诊或择期行再造术，切取皮瓣范围13mm×6mm～16mm×9mm。结果 术后皮瓣全部成活。经2~14个月，随访平均6.5个月。消除第2趾腹膨大及颈部狭窄畸形，再造指外形美观。指腹感觉无减退，两点辨别觉6～10mm，功能恢复良好。根据手外科协会手功能评定标准评定，7例均为优。结论 第2趾趾腹菱形皮瓣移位改形法一期再造手指能消除指腹膨大及颈部狭窄畸形，使再造手指更美观。

TOE FIBULAR-DORSAL ARTERY FLAP ANASTOMOSED TO DORSAL DIGITAL ARTERY IN REPAIRING DORSAL SOFT TISSUE DEFECT OF FINGERS

Objective To discuss the effectiveness of free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers. Methods Between May 2010 and September 2015, 28 patients with dorsal soft tissue defect of fingers were treated, including 17 males and 11 females with an average age of 23.8 years (range, 15-55 years). The reasons of injuries were machine twist (15 cases), heavy pound (4 cases), the sharp cut (5 cases), and hot crush (4 cases). The time from injury to admission was 30 minutes to 12 hours (mean, 1.5 hours). The involved fingers included thumb (3 cases), index finger (8 cases), middle finger (6 cases), ring finger (6 cases), and little finger (5 cases). The area of soft tissue defects ranged from 2.0 cm×1.5 cm to 3.5 cm×2.5 cm, and the area of free toe fibular-dorsal artery flap ranged from 2.8 cm×1.7 cm to 3.8 cm×2.8 cm. The blood supply of the flaps were reconstructed by anastomosing the toe fibular-dorsal artery, vein, and nerve to the dorsal digital artery, vein, and nerve, respectively. The donor site was repaired by free skin graft. Results The operation time was 1.5-5.5 hours (mean, 2.5 hours); the blood loss during operation was 10-50 mL (mean, 30 mL). Vessel crisis occurred in 1 case, and the flap survived after symptomatic treatment. The other flaps survived and the wounds healed with stage I; the skin grafts at donor site survived and the incisions healed with stage Ⅰ. Twenty-eight cases were followed up 6-24 months (mean, 8 months). The appearance of flaps was good, and two-point discrimination was 3.5-12.0 mm (mean, 5.3 mm) at 6 months after operation. The fingers function of grab and pinch recovered. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 20 cases and good in 8 cases, with an excellent and good rate of 100% at 6 months after operation. The donor sites of toe were smooth and had no depression. The patients had normal gait. Conclusion Free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers can obtain satisfactory effectiveness in appearance and function of fingers, and has the advantages of modified repair and less injury at donor site.

游离尺动脉腕上皮支下行支皮瓣修复手指皮肤缺损

目的 总结尺动脉腕上皮支下行支皮瓣游离移植修复手指软组织缺损的临床效果。 方 法 2008 年1 月－ 2009 年1 月，采用以尺动脉腕上皮支下行支作供血的尺动脉腕上皮支皮瓣游离移植修复手指软组织缺损10 例。男6 例，女4 例；年龄18 ～ 45 岁，平均38 岁。机器绞伤4 例，压砸伤3 例，切割伤3 例。缺损部位：手指近中节掌侧缺损2 例，手指中末节缺损3 例，手指侧方缺损3 例，指背近中节缺损1 例，指腹缺损1 例。缺损范围2.0 cm × 1.8 cm～ 6.0 cm × 4.0 cm。伤后至手术时间5 ～ 7 d。皮瓣切取范围2.0 cm × 1.8 cm～ 7.0 cm × 5.0 cm。供区直接拉拢缝合或植皮修复。 结果 1 例术后12 h 出现动脉危象，2 例术后24 h 皮瓣出现张力性水疱；其余皮瓣及供区植皮均顺利成活，切口Ⅰ期愈合。患者术后均获随访，随访时间1 ～ 2 年。皮瓣颜色及质地与周围正常皮肤相似，手指外形满意。术后1 年按中华医学会手外科学会上肢部分功能评定试用标准评定：优6 例，良3 例，可1 例，优良率90%。 结论 采用尺动脉腕上皮支下行支作供血的尺动脉腕上皮支皮瓣游离移植修复手指软组织缺损，切取方便，供区隐蔽且损伤小，外形和功能良好，是修复手指软组织缺损较理想的方法之一。

掌指骨牵引延长术治疗手指部分缺损

自1989年以来,采用手指延长器治疗手指部分缺损患者19例,37个手指。其中第一掌骨延长1个,近节指骨延长15个,中节指骨延长21个。平均延长2.1cm。全部达到骨愈合。不影响手指血循环及末端的感觉。

VENOUS SKIN GRAFT IN THE REPAIR OF SKIN DEFECTS OF FINGER REGION

Patients receiving venous skin grafts having 3 different patterns of nutrient supply were introduced. It was considered that the venous skin graft had contain role in the repair of skin defects of fingers and dorsum of hands. The mechanism of the survival of the venous skin graft was discussed. It was assumed that, in the early stage, the skin nutrient was possibly in relation with the effusion or exudation from the wound surface, and in the later stage, depended upon the collateral circulation established with the surrounding tissues.

尺动脉腕上皮支游离皮瓣修复手指掌侧软组织缺损

目的 总结尺动脉腕上皮支游离皮瓣修复第2～5指掌侧皮肤软组织缺损的临床效果。 方 法 2003 年5 月－ 2009 年10 月，收治第2 ～ 5 指掌侧皮肤软组织缺损17 例19 指。男12 例，女5 例；年龄21 ～ 53 岁，平均38.6岁。机器伤12 例，交通事故伤3 例，切割伤2 例。损伤指别：示指5 例，中指6 例，环指4 例，小指4 例；其中2 例为相邻两指。14 例为急性损伤，伤后至入院时间为10 min ～ 7.5 h；3 例为伤后彻底清创后感染创面。创面范围5.0 cm × 1.5 cm ～ 7.5 cm × 4.5 cm。应用大小为6.5 cm × 2.5 cm ～ 9.0 cm × 6.0 cm 的尺动脉腕上皮支游离皮瓣修复缺损，供区直接缝合或游离植皮修复。 结果 术后1 ～ 6 d 4 例出现表皮张力性水疱，3 例皮瓣远端部分坏死，经对症处理后皮瓣成活；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区切口均Ⅰ期愈合，植皮均成活。术后14 例获随访，随访时间6 个月～ 2 年6 月，平均1.3 年。皮瓣外形、质地、色泽均满意，两点辨别觉8 ～ 20 mm。手指功能参照关节主动活动度法（TAM）评定，获优8 例，良5 例，可1 例。 结论 尺动脉腕上皮支游离皮瓣是修复第2 ～ 5 指掌侧皮肤软组织缺损的有效方法之一。

指动脉逆行皮瓣与邻指皮瓣瓦合修复单指中远节皮肤缺损

第二足趾复合皮瓣与口止母趾腓侧皮瓣移植修复手指组织缺损

小儿手指掌侧瘢痕屈曲畸形矫正术后早期挛缩原因分析

【摘 要】 目的 回顾性分析小儿手指掌侧瘢痕屈曲畸形矫正术后早期挛缩的原因。 方法 2002 年1 月－2006 年1 月，收治98 例347 指掌侧瘢痕屈曲畸形，行掌侧瘢痕切除松解中厚皮片植皮术。男52 例185 指，女46 例162 指。年龄9 个月～ 6 岁。病程3 个月～ 2 年，平均7 个月。烫伤80 例，火焰烧伤18 例。每例为1 ～ 7 个伤指不等。瘢痕切除后，采用1.2 cm × 0.7 cm ～ 6.0 cm × 2.2 cm 中厚皮片修复。 结果 术后5 例12 指伤口Ⅱ期愈合，余均Ⅰ期愈合。患儿获8 ～ 12 个月随访，术后早期挛缩9 例20 指，发生率占患儿9.2%，占术指5.8%。发现早期挛缩后，积极加强防瘢痕处理及功能锻炼。余患儿皮片成活良好，手指活动正常。 结论 小儿手指掌侧瘢痕屈曲畸形一旦影响功能，应尽早手术。术前仔细准备，掌握手术要领和技巧, 术后坚持长期有效的防瘢痕治疗及功能锻炼，有助于减少术后早期皮片挛缩的发生。

废弃手指远位寄养二期回植再造手

目的 总结废弃手指远位寄养二期回植再造手、重建手功能的方法。 方法 2005 年2 月－ 2008 年12 月，将5 例远断端完整而近断端毁损无法一期再植的废弃拇指远位寄养，将拇指一侧指固有动脉与健侧腕部尺动脉腕上皮支下行支或足背跗外侧动脉吻合，并吻合2 条浅静脉，成活后1.5 ～ 3.0 个月将拇指二期回植于手部再造手。男3 例，女2 例；年龄7 ～ 43 岁。受伤至就诊时间1 ～ 3 h，拇指缺血时间3 ～ 6 h。 结果 5 例均获随访，随访时间11 个月～ 4 年。废弃手指远位寄养回植再造手均成活，回植拇指外观饱满，色泽红润。两点辨别觉8 ～ 10 mm。2 例行拇对掌功能重建术者恢复对掌功能；3 例未行拇对掌功能重建术者中1 例恢复部分对掌功能，2 例无对掌功能。手部功能依据中华医学会手外科学会拇、手指再造功能评定试用标准评分为7 ～ 13 分，平均9.2 分；其中优1 例，良4 例。 结论 废弃指远位寄养二期回植再造手是一种可行且有效的手术方法。