游离腕横纹皮瓣在桥接复杂性断指再植中的应用

摘要

(Department of Hand and Foot Surgery, Renci Hospital Xuzhou City, Xuzhou, Jiangsu, 221004, China) Abstract: Objective To investigate the application of free transverse wrist crease flap in the replantation of complex severed finger.Methods Between February 2015 and August 2016, 7 severed fingers with soft tissue defects, such as blood vessel, nerve tendon and so on, were bridged with free wrist crease flap to reconstruct the blood vessel and repair the wound, nerve and tendon. The survival condition was observed, and the function exercise was guided. The shape, movement and sensation of the patients were followed up. Results All flaps and severed fingers survived well in 7 cases. After 10 to 26 months' follow-up, the shape, color and texture of the flap were satisfactory. The flap had protective sensation. Part of two-point discrimination was 20 mm, and no skin flap repair at last follow-up. The replanted finger had good shape. At last follow-up the sensibility of finger pulp was S3 to S4. Two-point discrimination was 5 to 10 mm, and mean was 7.0 mm. Recovery of finger function was satisfactory. There was only linear scar in the donor site, and the wrist joint was good. According to the Chinese Medical Association of hand surgery to the upper extremity functional evaluation standard the results were excellent in 3 cases, good in 3 cases, and poor in 1 case, and the excellent and good rate was 86%. Conclusion The use of free transverse wrist crease flap to bridge severed fingers with vessel, nerve, tendon, skin and soft tissue defects can save severed finger and reduce the shortening degree of the finger, is an ideal way of operation.%目的 探讨游离腕横纹皮瓣在桥接复杂性断指再植中的应用价值.方法 2015年2月-2016年8月,对7例手指完全离断合并血管、神经、肌腱等皮肤软组织缺损的复杂性断指,采用游离腕横纹皮瓣桥接断指血管,重建血运的同时修复创面、神经、肌腱.观察其成活情况,指导功能锻炼,随访其外形、运动、感觉情况.结果 7例皮瓣及断指均成活良好,经 10～26个月随访,皮瓣外形、色泽及质地均较满意,末次随访时皮瓣均有保护性感觉,部分两点辨别觉达20 mm,均未行皮瓣修整.再植指体外形良好,末次随访时指腹感觉为S3～S4,末节指腹两点辨别觉为5～10 mm,平均7 mm,手指功能恢复满意.皮瓣供区仅遗留线形瘢痕,腕关节活动良好.根据中华医学会手外科学会上肢部分功能评定试用标准:优 3例,良 3 例,差1例,优良率86%.结论 应用游离腕横纹皮瓣桥接伴有血管、神经、肌腱等皮肤软组织缺损的复杂性断指,可以挽救濒临废弃的断指,也能减少患指的短缩程度,是一种较好的手术方式.