足部一蒂多瓣游离移植修复手部多处皮肤软组织缺损临床应用及疗效观察.docVIP

足部一蒂多瓣游离移植修复手部多处皮肤软组织缺损临床应用及疗效观察 　　[摘要] 目的 探讨足部一蒂多瓣游离移植修复手部多处皮肤软组织缺损的临床效果。 方法 以我院23例手部多处皮肤软组织缺损患者为研究对象，均予以足部一蒂多瓣游离移植修复，观察修复效果。 结果 23例患者移植皮瓣均成活，随访18个月，23例患者的皮瓣外形良好，患者满意度为95.7%，患者手部外形和功能评分为（7.6±0.8）分，优良率91.3%。该组患者随访中供区创面均愈合，且功能无明显影响。 结论 足部一蒂多瓣游离移植修复手部多处皮肤软组织缺损效果良好 [关键词] 手损伤；外科手术；移植修复；多处缺损 [中图分类号] R658.2 [文献标识码] B [文章编号] 1673-9701（2017）12-0055-04 [Abstract] Objective To explore the clinical effect of the repair of multiple hand skin and soft tissue defects by free implantation of one pedicle and multiple flaps of foot. Methods A total of 23 patients with multiple hand skin and soft tissue defects treated in our hospital were selected as the study subjects. They were all given the repair by free implantation of one pedicle and multiple flaps of foot. The repair effect was observed. Results All the 23 patients who were implanted by flaps all survived， followed up for 18 months. 23 patients had a good flap shape， with the patients’ satisfaction degree of 95.7%. The patients’ hand shape and function score was（7.6±0.8）， with the excellent good rate of 91.3%. The patients were followed up and the wound surface was all healed， and the function was not significantly affected. Conclusion The repair of multiple hand skin and soft tissue defects by free implantation of one pedicle and multiple flaps of foot is effective. [Key words] Hand injury； Surgery； Implantation repair； Multiple defects 手部多?皮肤软组织缺损多合并关节、肌腱、血管等外露，是手外伤的严重类型，严重影响患者的生活和工作。传统多采取腹部皮瓣修复，但该手术后期需多次手术，增加患者痛苦，且不利于手部功能的康复[1]。皮瓣修复仍是修复手部软组织缺损的理想方案，皮瓣的质地结构同手部相近，且血供丰富，对手部外形维持和功能恢复有重要临床价值。足部皮瓣可利用动静脉系统同受区吻合，达到良好的生理修复，降低手术风险[2，3]。手背部具有质地薄、皮下组织少、移动性较大等特点容易导致皮肤撕脱、坏死，多合并伸肌腱和掌骨外露，若处理不当则导致畸形。因此修复缺损时不仅要求正常形态、结构，更需要尽早恢复手的感觉和运动功能。手指缺损修复要求较高，如外观、关节的运动、皮肤的感觉等，手指的特殊功能与其特殊皮肤解剖结构有密切关系[4，5]。足和手同源，皮瓣质地及结构与手相接近、血供丰富、带有感觉神经，修复后手能恢复精细感觉，外形及功能和健手基本相同，因此足部逐步成为修复手部皮肤软组织缺损的理想供区。本文对足部一蒂多瓣游离移植修复手部多处皮肤软组织缺损的临床效果进行探讨，现报道如下 1 资料与方法 1.1 一般资料 随机选取2013年6月～2014年6月我院23例手部多处皮肤软组织缺损患者为研究对象，男18例，女5例，年龄18～52岁，平均（35.6±9.6）岁，致伤原因：重物致伤10例，机器致伤