摘要：
Objective To evaluate the application efficacy of Venous Skin Flap in treatment of skin degloving injury of fingers. Methods From June 2012 to December 2015, our hospital found different degrees of skin degloving injury at 18 parts of fingers of 15 patients. Firstly, the treatment was given to the different degrees of skin degloving injury of fingers by free transplantation of apple section shaped, rectangular and long-strip venous skin flap of forearm. For the patients with skin degloving injury at the distal interphalangeal joint of fingers, we designed the combined transplantation of apple section shaped venous skin flap and repaired 5 fingers; for the patients with the skin degloving injury away from the proximal interphalangeal joint, we designed the rectangular venous skin flap transplantation and repaired 7 fingers;and for the patients with the skin degloving injury near the proximal interphalangeal joint and even the whole fingers, we designed the screw-type transplantation of long-strip skin flap and repaired 6 fingers. Results All skin flats survived, except that a few part of skin flap edges had necrosis in 1 case and survived by dressing change and secondary debridement and suture; and with the follow-up visit for 3 to 24 months after the operation, the skin flap was thin and not bulky, the texture was soft, had no obvious contracture and pigmentation, the appearance was satisfied and the pain and warm sense was close to be normal, the two-point discrimination of venous skin flap with nerve repairment was 7 to 11 mm, the fingers repaired with the venous skin flap was stable in holding, and the functional recovery was good. No dysfunction in the donor area was presented, except for the normal scar. Conclusion According to the therapeutic effect on the different degrees of skin degloving injury of single finger or double fingers by the different shapes of free vein skin flap transplantation and repairment, it prompted that: it is a good therapeutic method. Other therapeutic methods are suggested for the skin degloving injury of above three fingers, whole fingers or whole hands.%目的 探讨静脉皮瓣在治疗手指皮肤脱套伤中的临床应用效果.方法 2012年6月-2015年12月,对15例18指手部不同程度皮肤脱套伤分别采用"苹果剖面"形、矩形及条形前臂静脉皮瓣游离移植的方法修复.其中对5指手指远侧指间关节部皮肤套状撕脱伤采用"苹果剖面"形静脉皮瓣瓦合移植修复;对7指近侧指间关节部以远皮肤套状撕脱伤采用矩形静脉皮瓣移植修复;对6指近侧指间关节部以近至全手指皮肤套状撕脱伤采用长条形皮瓣螺旋式移植修复.结果 术后除1例皮瓣边缘少部分坏死,经换药及二次扩创缝合后成活,其余皮瓣全部成活.经3~24个月随访,皮瓣薄且不臃肿,质地柔软,无明显挛缩及色素沉着,外形满意,痛温觉接近正常,修复神经的静脉皮瓣两点辨别觉为7~11 mm,静脉皮瓣修复的手指持物稳定,功能恢复良好.供区除正常瘢痕外无功能障碍.结论 对于单指或双指不同程度皮肤脱套伤釆用不同形状静脉皮瓣游离移植修复,是一种较好的治疗方法.对三指以上、全手指或全手皮肤脱套伤仍建议选用其他治疗方法.
