高顺红第二足趾甲皮瓣课件.pptVIP

第二趾甲皮瓣联合手指岛状皮瓣治疗手指脱套伤 河北联合大学附属骨科医院（唐山市第二医院） 手二科 高顺红 概 述 手指环形脱套伤是一种非常严重的损伤 受伤机制包括挤压、离断、撕脱 造成手指广泛的宏观及微观的损伤 损伤程度从手指皮肤的磨损到完全的离断或套脱 自从希波格拉底（Hippocrate约公元前460-前377）年代，人们就知道这种损伤预后很差 随着更多的机器、楼梯扶手、游戏娱乐进入我们的生活，这种损伤司空见惯 Ring Avulsion Classification （Urbaniak etal 1981 ） Class I Circulation adequate. Standard bone and soft tissue treatment is suf?cient Class II Circulation inadequate. Vessel repair preserves viability permitting immediate or delayed repair of other tissues Class III Complete degloving or completed amputation. Judgement is essential because, although a complete amputation can be revascularised and viability restored, the potential for function is limited. In degloving injuries, the potential for useful function exists, but revascularisation is not easy or may not be possible Ring Avulsion Classification （Kay etal 1989 ） Grade I: Circulation is adequate with or without skeletal injury Grade II: Arterial or venous circulation is inadequate (arterial or venous), and there is no skeletalinjury Grade III: Arterial and venous circulation is inadequate, and there is skeletal injury Grade IV: Complete amputation Kay S, Werntz J, Wolff TW. Ring avulsion injuries: classification and prognosis. J HAND SURG 1989;14A:204-213. Ring Avulsion Classification（ Adani etal 1996/2003） Class I Circulation adequate Class II Circulation inadequate (arterial or venous) with no bone injury Class III Circulation inadequate (arterial or venous) with fracture or joint injury Class IVd/IVp Complete amputation/degloving distal (IVd) or proximal (IVp) to the insertion of ?exor digitorum super?cialis Class IVi Complete degloving with intact tendons 治疗方法 Gillies (1940)首先报道带蒂皮瓣治疗手指脱套伤，开启了脱套伤的重建先河(stump revision or ray resection before 1940) 从1944年开始不同治疗方法不断涌现 1950年Gurdin Pangman首次报道了利用邻指皮瓣治疗手指皮肤缺损 1962年Kleinert Kasden首次行拇指不全离断再血管化 1965年Komatsu Tamai 首次行拇指不全离断再植 从此，显微外科技术运用于手指脱套伤的治疗 Kurata于1978年报道了对不完全撕裂或脱套的套状皮肤进行在血管化实验研究 Nissembaum19