邻指皮瓣及腹部皮瓣修复指腹缺损疗效对比研究.docVIP

邻指皮瓣及腹部皮瓣修复指腹缺损疗效对比研究[摘要]目的：探讨指背及腹部皮肤组织学特点，总结对比邻指皮瓣与腹部皮瓣在修复指腹皮肤软组织缺损的临床效果及优缺点。方法：2006年以来，40例伴肌腱或骨组织外露指腹皮肤软组织缺损患者，缺损范围:1.5cm×1.0cm～3.0cm×2.0cm。根据病情应用邻指皮瓣修复患者20例，腹部皮瓣修复患者20例。邻指皮瓣3周断蒂，腹部皮瓣4周断蒂。术后分别对两种皮瓣修复术后的外观、两点辨别试验及功能满意度进行随访调查，并进行对比分析。结果：38例皮瓣成活无坏死感染，2例腹部皮瓣修复患者切口处皮瓣边缘局部坏死，给予换药后自愈。术后随访6个月～2年，用腹部皮瓣修复患者皮瓣较为臃肿、皮色较深、两点辨别能力及患者功能满意度差，但可修复面积较大指腹缺损患者；而用邻指皮瓣修复患者外观、功能较好，但修复面积有限。结论：在条件允许下应用邻指皮瓣修复指腹皮肤软组织缺损较腹部皮瓣更为理想。 [关键词]外科皮瓣；手外伤；显微外科手术 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2011）05-0721-02 Comparative study on therapeutic effects of cross finger skin flaps and abdominal skin flaps in the repair of pulp skin and soft tissue defects QIN Yong-ping,JI Liu,LI Qing-tai,LIU Mu-qing,LIANG Bo,YU Zhi-jun,QIN Heng-yi,XU Min-na (Department of Hand Surgery,Yuquan Hospital of Tsinghua University,Beijing 100049,China) Abstract:ObjectiveTo study the histological features of dorsal and abdominal skin, and summed up the clinical effect of cross finger skin flaps and abdominal skin flaps in the repair of pulp skin and soft tissue defects,in order to compare the advantages and disadvantages.MethodsSince 2006, 40 cases of pulp skin and soft tissue defects underwent cross finger skin flaps and abdominal skin flaps. 20 patients with cross finger skin flaps, 20 patients with abdominal flaps. followed up of satisfaction after the surgerys.Results40 cases without infection. 2 cases of abdominal skin flaps with partial edge necrosis and wound healing to. followed up for 6 months to 2 years, its more bloated and soft with the abdominal skin flaps, and with the cross finger skin flaps is ideal.ConclusionThe cross finger skin flap is more desirable than the abdominal skin flaps to repair of the pulp skin and soft tissue defects. Key words:surgical flap; hand injuries; microsurgery 指端缺损在手外伤中占有较大比重[1]，其中指腹皮肤软组织缺损更为常见，指腹对手部的功能及外观都较为重要，如何提高指腹缺损的治疗效果，使其功能与外观更为接近正常手是临床上较为重要的课题，临床常用指背皮瓣及腹部皮瓣对其进行修复，笔者通过对指背、指腹及腹部皮肤的组织学特点出发，对邻指皮瓣及腹部皮瓣修复指腹缺损的病例进行总结，从而进一步指导手术的治疗。 1资料和方法 1.1 临床资料：本组共40例40指，其中男25