吻合血管皮瓣移植修复前臂和手部复杂性软组织缺损_临床医学论文.docVIP

吻合血管皮瓣移植修复前臂和手部复杂性软组织缺损_临床医学论文 吻合血管皮瓣移植修复前臂和手部复杂性软组织缺损_临床医学论文 作者：甘干达，唐继全，扈克治，陶智刚，罗平 【摘要】 目的 探讨吻合血管皮瓣移植修复前臂和手部复杂软组织缺损的临床效果。方法 对17例前臂和手部复杂软组织缺损采用股前外侧皮瓣、胸脐皮瓣、小腿内侧与股前外侧皮瓣的串联皮瓣游离移植修复创面。创面面积11cm×8cm～26cm×9cm，皮瓣切取面积13cm×9cm～27cm×10cm。结果 移植皮瓣全部成活;8例皮瓣臃肿，需再次手术整形;4例骨缺损在皮瓣成活后半年施行自体髂骨植骨钢板内固定，骨折愈合，前臂的旋转功能和手部功能恢复满意;3例肌腱缺损者术后3～5个月用健侧掌长肌腱或手屈指浅肌腱移植修复，手部功能获得部分恢复;2例尺、桡动脉严重损伤，合并重度皮肤肌肉组织缺损者手部功能获得部分恢复，其余患者前臂旋转功能和手部功能恢复满意。结论 吻合血管皮瓣移植能有效地修复前臂和手部复杂软组织缺损，控制创面感染，有助于骨折愈合和手部功能的恢复。 【关键词】 软组织缺损;皮瓣移植;组织修复;前臂;手部 　　【Abstract】 Objective To discuss the clinical effect of vascularized flap transplantation in repairing soft tissue defects in forearm and hand.Methods Totally 17 patients with forearm and hand complex soft tissue defects were treated using the anterolateral thigh flap,thoracoumbilical flap, medial leg flap combined with anterolateral thigh flap to repair the wound.The wound area ranged from 11cm×8cm to 26cm×9cm,and the flap area from 27cm×10cm to 13cm×9cm.Results Flaps survived completely;enlargement in transplanted flap was found in 8 cases requiring reoperation; four cases of bone defect were treated with autologous iliac bone graft with internal fixation,resulting in healing fracture and satisfactory forearm rotation and hand function;three cases of tendon defects were repaired with palmaris longus tendon graft and superficial flexor tendon graft 3 to 5 months after surgery, resulting in partial recovery of hand function;partial recovery of hand function was achieved in 2 cases of severe injury radial artery and ulnar artery combined with severe muscular tissue defect.The remaining patients recovered satisfactorily in forearm rotation and hand function.Conclusion Vascularized flap can effectively repair the complex soft tissue defects in forearm and hand,control the wound infection, which is helpful for fracture healing and functional recovery of hand. 　　【Key words】soft tissue defect;flaps transplantation;tissue repair;forearm;hand 　　随着工业的发展，前臂和手部严重损伤合并软组织缺损已不少见。由于创伤严重，组织缺损较多，治疗上比较困难。