短蒂腹部交叉皮瓣修复手部创面的临床应用.docVIP

PAGE PAGE 1 短蒂腹部交叉皮瓣修复手部创面的临床应用 　　[摘要]目的：探讨短蒂腹部皮瓣修复手部创面的广泛适用性及改进方法。方法：通过改进皮瓣设计及闭蒂方式、采用短蒂腹部皮瓣修复手部创面25例32处，手指19例（其中同侧双指3例、三指2例）、手背6例。皮肤缺损范围：最小1.5cm×2.0cm、最大12cm×16cm。皮瓣范围：最小1.8cm×2.5cm、最大13cm×18cm。结果：所有皮瓣蒂部均一期闭合、术后一周蒂部干洁、皮瓣成活良好、质地外观佳，手功能恢复良好。结论：腹部皮瓣修复手部创面大多无需设计皮管，改进皮瓣设计及闭蒂方式的短蒂腹部皮瓣即可达到封闭创面、减少渗出及感染机会，同时提高皮瓣利用率、减少副损伤、避免皮管臃肿、积血影响血供、促进血循环及感觉重建、可早期断蒂、利于功能恢复、外形更薄。 　　[关键词]蒂部；腹部皮瓣；手部创面；设计改进；临床应用 　　[中图分类号]R622[文献标识码]A[文章编号]1008-6455（2013）01-0118-02 　　ClinicalApplicationoftheAbdominalFlapwithShortPedicelfortheWoundofHand 　　TIANHeng，LIUHong-jun，GUJia-xiang，ZHANGNai-chen，PANJun-bo，ZHANGWen-zhong 　　（NorthernJiangsuPeoplesHospitalAffiliatedtoYangzhouUniversity，Handsurgery，Yangzhou225001，Jiangsu，China） 　　Abstract：ObjectiveTodiscusstheextensivefeasibilityandimprovedmethodsoftheabdominalflapwithshortpedicelforthewoundofhand.Methods25caseswith32woundsintheirhandswererepairedbytheimprovedabdominalflapwithshortpedicel，whichimprovedintheflapdesignandmethodsofpedicelclosure，ofwhom19caseswiththeskindefectofthefingers（3casesofwhomwithdoublefingersdefectinthesamehand，and2casesofwhomwiththreefingers），other6caseswoundonthebackofthehand.Thesizeofskindefectwas1.5cm×2.0cmto12cm×16cm；thesizeoftheflapswas1.8cm×2.5cmto13cm×18cm.ResultsAllcasespedicelwereclosedinoperationanddryinaweekafteroperation，allflapsachievedacompletesurvival、thetextureandappearanceweresatisfying，andhandfunctionweregood.ConclusionSkintubewasunnecessaryfortheabdominalflaptorepairthewoundofhandgenerally，theimprovedabdominalflapwithshortpedicelwhichimprovedintheflapdesignandmethodsofpedicelclosurealsocouldclosewound、decreaseexudationandinfectionprobability，andincreasetheutilizationrateofflap、reduceadditionaldamage、avoidswollensikntubeandhematoceletoaffecttheflapsbloodsupply，promotebloodcirculationandsensationreconstruction，cutthepedicleandfunctionrecoverearly，andappearancewasmorethin. 　　Keywords：pedicel；abdominalflap；handwound；improveddesign；clinicalapplication 　　腹部皮瓣因其操作简便、成活可靠、供区隐蔽、灵活实用等优点被作为手、前臂创面修复的常规选择[1]，然而传统腹部皮瓣因蒂部需闭合形成管