腹部皮瓣修复上肢复杂损伤108例

摘要

目的：探讨应用腹部皮瓣修复上肢复杂损伤的临床疗效及安全性。方法：回顾性分析2011年8月-2014年8月在本院接受腹部皮瓣修复上肢复杂损伤的108例患者的临床资料。术后随访6~12个月，观察修复效果。结果：108例患者皮瓣均成活，其中101例获得随访，随访率为93.5%。随访101例患者皮瓣血运良好，皮瓣质地柔软，厚度适中，触之弹性较好，皮瓣恢复保护性感觉，两点分辨觉15 mm左右。供区愈合良好，无明显瘢痕，仅有少量增生，上肢功能基本得到恢复。1例患者因皮瓣下血肿压迫出现皮瓣供血障碍，经拆除部分缝线后血运恢复；2例多指脱套损伤患者在修复后对外观不甚满意，经二期整形修复后满意出院；2例手部掌背两侧复合脱套伤患者修复后精细活动功能受到轻微的影响。101例随访患者中96例评价满意，满意率为95.0%。结论：腹部皮瓣适用于修复各类上肢复杂性损伤，安全可靠。不过，临床需要加强修复过程的护理，以切实减少后遗症，提高患者生存质量。%Objective:To investigate the clinical efficacy and safety of the application of abdominal skin flaps in the repair of complex defects of upper extremity.Method:The clinical data of 108 patients with complex defects of upper extremity who accepted abdominal skin flaps admitted to our hospital from August 2011 to August 2014 were retrospectively analyzed.The postoperative followed-up was taken for 6 to 12 months,the repair effects were observed.Result:All flaps of the 108 cases survived,and 101 cases got followed-up service,so the follow-up rate was 93.5%.The flaps of the followed-up 101 cases were soft with good blood circulation,the thickness of the skin was moderate,the elasticity of the skin was good with touching,the sense of protection of the skin flaps restored,the two-point-discrimination of the digits was 15 mm.The donor sites healed well without obvious scars, but with only a few hyperplasia,the function of the upper extremity was basically restored.There was blood supply disturbance of skin flaps appeared in 1 case due to sub skin-flap hematoma,the blood circulation restored after removing part of the suture.2 patients with multiple fingers degloving injury were not so satisfied with the appearance of the operated after restoration,they discharged satisfactorily after two-stage shaping and repairing.The fine motor function of 2 cases with volardorsal compound degloving injury were affected slightly after restoration.There were 96 cases of satisfaction evaluation from the 101 cases,the satisfaction rate was 95.0%.Conclusion:The abdominal skin flaps applies to repairing the complex injury of upper extremity,they are safe and reliable.However,clinical need to strengthen the repair process of nursing,so as to reduce the complications effectively,and improve the patients’ quality of life.