腹部双蒂预置皮瓣治疗大面积手部皮肤缺损.docVIP

腹部双蒂预置皮瓣治疗大面积手部皮肤缺损【摘要】目的：对腹部双蒂预置皮瓣治疗大面积手部皮肤缺损的总结。方法：2008年以来对手部大面积皮肤缺损患者采用腹部双蒂预置皮瓣15例，依照受区创面大小在下腹壁预置双蒂皮管，三周后断开一侧皮瓣蒂部，覆盖受区创面，三周后再次断蒂。结果：术后皮瓣均成活，1例患者因皮瓣滑脱行二次皮瓣转移术，1例患者创面感染行断蒂、扩创、植皮术，1例患者2次断蒂后远端皮肤出现部分坏死，其余均I期愈合。结论：腹部双蒂预置皮瓣能够修复大面积皮肤软组织缺损创面，操作简单，成活率高，供区隐蔽，缺点主要为病程长。 【关键词】腹部双蒂预置皮瓣；大面积皮肤缺损；手 Double-pedicel abdominal skin flaps used for treatment of a large area cutaneous deficiency of hands Zhou Ming, Deng Lin 【Abstract】 Objective To evaluate several double-pedicel abdominal skin flaps used for treatment of a large area cutaneous deficiency of hands. Method Since 2008, 15 patients with a large area cutaneous deficiency of hands were treated with dis-pedicel abdominal skin flaps. First, pre-set ting dis-pedicel abdominal skin flaps on hypogastric wall according to recipient site area. Second, one of pedicels of skin flaps was dissected to cover raw surface of recipient site. Last, another pedicel of skin flaps was cut off. Result All the skin flaps survived. One cured by transfer of skin flap again because skin flap amotic. One skin flap had distal cutaneous necrosis due to infection and cured by dermatoplasty afterward. The rest were healed at first stage. Conclusion The large area cutaneous deficiency of hands can be repaired by double-pedicel abdominal skin flaps. The method had several forteds such as simple operation, high survival rate, blanketed donor site. The disadvantage was long-course. 【Key words】 Double-pedicel abdominal skin flaps， Large area cutaneous deficiency， Hand 【中图分类号】R739.64【文献标识码】B【文章编号】1008-6455（2011）08-0165-01 大面积皮肤缺损的手外伤治疗比较困难。在修复深部组织之前必须覆盖皮肤缺损。我院从2008年至2010 年应用腹部双蒂预置皮瓣治疗大面积手部皮肤缺损15例患者，效果满意，报道如下。 1 资料与方法 1.1 一般资料:本组15 例，男11例，女4 例，年龄22～45岁。手掌皮肤缺损5 例，手背皮肤缺损3 例。虎口区皮肤缺损3例，随访6个月至24个月。 1.2 方法:根据受区皮肤缺损创面的大小于下腹壁做上、下两处横形手术切口，长宽比为3～4：1，在皮下浅筋膜层进行剥离，直至上下切口完全贯通， 将皮瓣两侧切口皮肤，修剪皮下多余脂肪组织，内翻直接缝合，形成双侧带蒂皮管，若供皮区创缘皮肤张力允许则直接缝合，反之则行刃厚皮片游离植皮。三周后断开一侧皮瓣蒂部，将皮管纵行切开，形成单蒂皮瓣，覆盖受区创面，三周后再断开另外一侧皮瓣蒂部。对虎口区皮肤缺损患者，为防止术中和术后拇指发生内收倾向，常规用直径1.5mm克氏针横穿固定第一、二掌骨以维持