上肢微型游离皮瓣修复手指皮瓣缺损

摘要

目的 探讨上肢微型游离皮瓣修复各种外伤所致手指皮瓣缺损的方法及疗效.方法 回顾性分析我院2015年7月~2016年7月手外伤科行上肢微型游离皮瓣修复手部皮瓣缺损的患者102例共118指,其中右手68例,左手34例,拇指皮瓣缺损48例,食指30例,中指20例,环指15例,小指5例,均为不规则创面,面积(1.5 cm×2.0 cm)~(3.0 cm×5 cm).结果 本组102例患者(118指)均顺利完成手术修复缺损,118指皮瓣均顺利存活,均随访6个月.所有患者手指创面外观恢复良好,均无需再次手术修复.供、受区伤口均直接缝合并Ⅰ期愈合,供区仅残留局部线性瘢痕.术后出现静脉危象4例,经局部皮瓣按摩、红外线理疗等对症处理后症状消失;未见其他严重不良反应.根据《中华医学会手外科学会上肢部分功能评定使用标准》评价疗效,优38指,良74指,差6指,优良率为94.9%.结论 上肢微型游离皮瓣修复各种外伤所致手指创面是较为理想的手术方法,术后效果满意,并发症少.%Objective To investigate the surgical methods and the therapeutic effect of miniature free skin flap of upper extremities on repairing the traumatic finger flap defects . Methods A total of 102 patients (118 fingers) with hand flap defects repaired by miniature free skin flap of upper extremities from July 2015 to July 2016 were retrospectively analyzed, including 68 cases of right hand and 34 cases of left hand.The soft tis-sue defect of finger located on thumb in 48 fingers, index finger in 30, digitus medius in 20, ring finger in 15 and digitus minimus manus in 5.All the wounds were irregular and the wound area ranged from 1.5 cm ×2.0 cm to 3.0 cm ×5 cm after the wound debridement . Results The wounds achieved primary healing and the flaps survived in all 102 cases with 118 fingers.All cases were followed up for 6 months.The appearance of the wounds of injured fingers recovered well without re -operation.The wounds of donor and recipient site were healed by suturing.The venous crisis was found in 4 cases and relieved by management of massage of local flaps and physical therapy of infrared rays .According to the evaluation criteria of upper extremity functional activities of the Chinese Society of Surgery, the outcomes revealed excellent in 38 fingers, good in 74 fingers, and false in 6 fingers, and the excellent and good rate was 94.9%. Conclusion The miniature free skin flap of upper limbs is an ideal surgical method for repairing the traumatic fingers with satisfied effect and low complication rate .