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带蒂皮瓣修复手指软组织缺损

CLINICAL EVALUATION OF FROZEN PHALANX JOINT TENDON SHEATH COMPOSITE TISSUE ALLOGRAFT

OBJECTIVE: To evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen-phalanx-joint-tendon-sheath composite tissue allograft in 270 cases. METHODS: The patients were followed up with reexamination in the ambulant clinic, communication, X-ray photography, lab-examination, isotope 99mTc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years). RESULTS: Enveloping the allogeneic finger composite tissue with self-HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two-point discrimination was 3 mm to 15 mm. The junction between implanted allo-phalanges and auto-phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99mTc MDP was used to take X-ray photography in 24 cases for four months to 9 years and seven months, which showed that the blood vessels grew into the allo-phalanges. However, the Charcot’s arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft. CONCLUSION: The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self-phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption

足母 趾腓侧皮瓣修饰性修复拇手指掌侧皮肤缺损

【摘 要】 目的 介绍一种修复拇、手指掌侧皮肤缺损的理想手术方法。 方法 2001 年7 月－ 2006 年7 月，采用足母 趾腓侧皮瓣游离移植修复拇、手指掌侧皮肤缺损28 例。男16 例，女12 例；年龄14 ～ 46 岁。挤压伤11 例，冲床伤7 例，刀具割伤3 例，火器伤3 例，咬伤2 例，慢性溃疡2 例。拇指4 例，示指7 例，中指7 例，环指6 例，小指4 例。皮肤缺损2.0 cm × 1.5 cm ～ 4.0 cm × 2.5 cm。病程3 h ～ 7 d。皮瓣切取范围2.5 cm × 1.5 cm ～ 4.5 cm × 2.5 cm。供区直接缝合或全厚植皮修复。 结果 术后28 例供受区伤口均Ⅰ期愈合，移植皮瓣及供区植皮均成活。28 例获随访6 个月～ 5 年。皮瓣外形逼真，有罗纹，质地良好，两点辨别觉4 ～ 6 mm。按中华医学会手外科学会上肢部分功能评定试用标准：优25 例，良3 例。供足行走、跑、跳功能正常。 结论 足母 趾腓侧皮瓣修复拇、手指掌侧皮肤缺损，供区损伤小，对受区周围组织破坏小，修复后效果佳，能达到修饰性修复目的。

V-Y ADVANCEMENT OF VOLAR SKIN FLAPS PEDICLED BY DIGITAL AR-TERIES AND NERVES FOR RECONSTRUCTION OF DIGITAL SKIN DEFECT

The traditional Kutler and Atasoy V-Y advancement flaps have minimal advancement degree, did not satisfy to repair large skin defect in fingers, hence, have no wide indications. The sensory function of the fingers to be influenced because of injury of sensory nerves and sear formation. Since 1985 to 1991, the V-Y advancement flaps pedicled by bilateral digital arteries and nerves have been used for reconstruction of 33 finger tip defect and 5 digital volar skin contraction. All of these cases obtained satisfactory function and excellent appearance.In this paper, the anatomical charactistics and principles of devicerecommended, the advantages and key points to success discussed.

ILIO INGUINAL HYPOGASTRIC VASCULAR NETWORK SKIN FLAP WITH COMMON PEDICLE IN THE TREATMENT OF DEGLOVING INJURY OF MULTIPLE FINGERS

OBJECTIVE In order to solve the difficult problem of one-stage repair of degloving injury of multiple fingers, the common pedicled ilio-inguinal-hypogastric subdermal vascular network skin flap was designed and the multi-lobes skin flap was performed subsequently. METHODS From 1993 to 1996, there were 5 cases with degloving injuries of multiple fingers were treated by this flap. There were 2 males and 3 females and the age ranged from 7 to 19 years old. RESULTS After operation, the pedicles of the flap was detached between 12 to 16 days and all of the flaps survived completely. Patients were followed up for 6-18 months. After repair, the contour and skin colour of the digits were excellent, and the motion of the interphalangeal joints and skin sensation were good. CONCLUSION The conclusion was as follows: The newly designed skin flap was characterized by the advantages of duration of treatment being short, excellent contour and more rapid recovery of function. It could be used for one-stage repair of degloving injury of multiple fingers.

DOUBLE ADJACENT-FINGER SKIN FLAP IN THE TREATMENT OF SEVERE CICATRICIAL CONTRACTURE OF FINGERS

Double adjacent-finger skin flap could be used to treat severe cicatricial contracture of fingers with resultant complete release of contracture and good coverage of raw surface. From the follow-up, it was noted that the appearance of the fingers following treatment looked nice, no recurrence of contracture in the late stage, and partial sensation of the fingers could be recovered as well. It had no ill-effect on the donor fingers, The method was simple and reliable,from 1987, a total of 4 cases had been done,and the functional recovery wassatisfactory.

指神经血管蒂V—Y岛状推进皮瓣修复指端缺损

采用伤指一侧指神经血管蒂“V—Y”岛状推进皮瓣修复手指截断伤,是一种融“V—Y”皮瓣和指动脉岛状瓣为一体的综合手术方法。创面不需植皮,不再继续损失患指长度,一次完成修复,术后具备良好的两点辨别觉。临床应用6指,效果良好。

真皮下血管网皮瓣修复手指脱套伤38例

目的 探讨手部脱套伤中皮肤缺损的修复方法。 方法 1998年5月～2005年5月，根据手部脱套伤的皮肤缺损面积、形状设计髂腹股沟真皮下血管网皮瓣修复38例46指。其中拇指11指，食指20指，中指9指，无名指4指，小指2指，拇指、食指同时脱套伤3例。手术均一期修复，切取皮瓣为6 cm×2 cm～17 cm×8 cm。供区直接缝合9例，中厚皮片修复29例。 结果 46指皮瓣全部成活，术后10～12 d断蒂。供区创面均Ⅰ期愈合。获随访6～12个月，手部外形、功能满意。两点辨别觉＞10 mm。 结论 应用真皮下血管网皮瓣修复手指脱套伤具有操作简便，安全性高，实用性强，适于基层医院开展。

指动脉皮支皮瓣修复手指皮肤缺损

目的总结应用指动脉皮支皮瓣修复手指软组织缺损的方法及效果。 方法2008年8月－2014年8月，以指动脉皮支供血设计切取皮瓣修复2～5指软组织缺损52例65指，其中男36例，女16例；年龄18～66岁，平均39.6岁。创面缺损范围10 mm×6 mm～26 mm×22 mm。受伤至手术时间2～10 h，平均6.5 h。皮瓣切取范围13 mm×10 mm～30 mm×25 mm。 结果4例皮瓣有水疱形成，1例皮瓣远端皮缘坏死，均经相应处理后愈合；其余皮瓣均成活，切口Ⅰ期愈合。供区创面植皮Ⅰ期愈合。47例58指获随访，随访时间6～25个月，平均14.3个月。术后皮瓣外观及感觉良好，皮瓣感觉恢复达S3；两点辨别觉6～10 mm，平均7.8 mm。手指功能恢复满意，按手指总主动活动度（TAM）法评定获优39指，良17指，可2指，优良率96.6%。供区无瘢痕挛缩、肌腱粘连等并发症发生。 结论指动脉皮支皮瓣不牺牲主要血管、血供可靠，操作简便、安全，术后效果满意，是修复手指皮肤软组织缺损较理想方法。

EFFECTIVENESS OF MICROSURGICAL REPAIR OF FLEXOR TENDON RUPTURE BY NON-KNOT KESSLER SUTURE METHOD IN ANASTOMOTIC STOMA

Objective To analyze the effectiveness and advantages of the microsurgical repair of flexor tendon rupture with non-knot Kessler suture method in anastomotic stoma by comparing with the method of traditional Kessler suture. Methods Between February 2005 and February 2010, 122 patients (163 fingers with 243 flexor digital tendons) with flexor tendon rupture, were treated with microsurgical repair by non-knot Kessler suture method (treatment group); flexor tendon was sutured, and sodium hyaluronate was used to repair tendon membrane, tendon sheaths, and the tissue surroundingtendons. The cl inical data were analysed, and were compared with ones from 96 patients (130 fingers with 186 flexor digital tendons) with flexor tendon rupture treated with traditional Kessler suture between February 2001 and February 2005 (control group). There was no significant difference in gender, age, cause of injury, injury site, duration, and other general information between 2 groups (P gt; 0.05). Kleinert elastic traction therapy (dynamic-protection) was performed at 3 weeks after surgery, and the finger function exercise was done after 24 hours. Results Infection of incision occurred in 2 cases of the treatment group and in 5 cases of the control group, and were cured after 2 weeks of dressing change; the other incisions healed by first intention. The patients were followed up 6 to 14 months (mean, 9 months). In the treatment group, the total active movement (TAM) was (192.0 ± 13.1)°; the results were excellent in 54 cases, good in 58 cases, moderate in 8 cases, and poor in 2 cases with an excellent and good rate of 92%. In the control group, TAM was (170.0 ± 15.2)°; the results were excellent in 23 cases, good in 30 cases, moderate in 22 cases, and poor in 21 cases with an excellent and good rate of 55%. Significant difference in TAM was found between 2 groups (P lt; 0.01). Conclusion The microsurgical repair of flexor tendon with non-knot Kessler suture method in anastomotic stoma with repair of tendon membrane, tendon sheaths, and the tissue surrounding tendons is more effective than the traditional Kessler suture, but long-term effectiveness still needs further observation.