V-Y推进皮瓣在指端皮肤缺损临床应用体会.docVIP

V-Y推进皮瓣在指端皮肤缺损的临床应用体会 施保华 沈决心 上海市崇明县堡镇人民医院骨科 同济大学医学院09级研修班外科学 202157 【摘 要】 目的 探讨V-Y推进皮瓣在指端皮肤缺损修复的适应症和手术方法及应用体会。 方法 2005 年1月－ 2010年6月，收治126 例指端皮肤缺损伤患者。伤因:挤压伤39 例，切割伤67例，电锯伤20例。伴有指甲甲板脱落46例。损伤类型:横断面48指、偏背侧25指、偏掌侧44指、侧方缺损37指。缺损范围1.0 cm × 1.2 cm ～ 1.5 cm × 2.5 cm。伤后至手术时间3 ～ 10 h。改良的指腹V-Y皮瓣66例，改良的Kutler v-y皮瓣41例，应用Leonard的V—Y“CUP”瓣11例，改良的Moberg带指神经血管束的v-y皮瓣 3 周内愈合拆线；3例伤口感染4周愈合；2例皮瓣部分坏死换药6周愈合；1例皮缘发黑未做处理，后期随访8周愈合。患者均获随访，随访时间2 ～ 6 个月，平均3.5 个月。皮瓣外形饱满、质软，肤色和皮温均正常。46例甲板脱落患者除1例术后出现钩甲畸形，余指甲光滑、无压痛，甲床平整无甲棘；患指各关节活动无影响。 结论 对指端皮肤缺损根据损伤类型和缺损面积采用不同的修复方法，有利于最大程度恢复指尖功能和外形。严格掌握不同V-Y推进皮瓣手术适应症，熟悉手术解剖和手术技能是减少皮瓣坏死发生率的重要因素。 【关键词】指端缺损 V-Y皮瓣 甲床回植 THE CLINICAL EXPERIENCES OF USING V-Y ADVANCE FLAP FOR THE REPAIR OF THE FINGER TIP DEFECT SHI Baohua SHEN Juexin Department of Orthopedics, The People’s Hospital of BaoZhen; ChongMing ; ShangHai ; 202157 Department of Surgery, The Research And Advanced Studies Class Of Grade 09,The Medical College Of TongJi University ;Shanghai; 【Abstract】 Objective To investigate the clinical experiences of using different v-y advance flap for the repair of the fingers tip defect . Methods From January 2005 to June 2010, 126 cases of 154 fingers with fingertip defect , including 76 males 83 fingers and 50 females 71fingers, aged 7-76 years, were treated. 126 patients (39 crush injuries, 67 cutting injuries and 20 sawing injuries) were classified into 4 types, 48 fingers with traverse amputation injuries, 25 fingers with partial back side defect ,44 fingers with partial slap defect,37 fingers with profile defect. The soft tissue defect ranged from 1.0 cm ×1.2 cm to 1.5 cm × 2.5 cm. The time from injury to surgery was 3-10 hours. 66 fingers using the ameliorated finger abdomen v-y advance flap, 41 fingers using the ameliorated Kutler v-y advance flap, 11 fingers using Leonard v-y cup advance flap, 23 fingers using the ameliorated Moberg contain Nerves and blood vessels v-y advance flap, 13 fingers using the compounded v-y advance flap. Emerged nail bed injuries shoul