真皮下血管网皮瓣在手外伤修复中的应用

STUDY ON THE EFFECT OF PEDICLE SKIN FLAP OF SUBDERMAL VASCULAR PLEXUS ON REPAIRING THE HAND INJURY

目的总结真皮下血管网皮瓣修复手外伤创面手术时机及效果。方法1999年1月～2004年6月,应用胸腹部带蒂真皮下血管网皮瓣修复手部皮肤软组织缺损创面22例,其中男17例,女5例。年龄9～42岁。撕脱伤12例,碾压伤2例,热压伤5例,电烧伤3例;急诊手术13例,3～7d手术9例。手术依创面情况选择胸部或下腹部皮瓣,修薄皮下脂肪保留2～4mm。对于多指损伤,将皮瓣设计成2～3叶,形成多个带蒂真皮下血管网皮瓣,手部缺损区分别置于皮瓣内。结果术后1例皮瓣远端小部分坏死,经换药后愈合,余21例皮瓣完全成活。术后随访3个月～2年,受区皮肤平整、色泽好、质地软,断蒂后不须修整,外形美观,功能恢复满意。术后3～6个月有触觉及痛温觉恢复。结论应用胸腹部带蒂真皮下血管网皮瓣修复手部皮肤软组织缺损具有疗程短,术后手外形及功能恢复佳等优点,是较理想的一种修复方法。

Objective To summarize the operation opportunity and recovery effect of pedicle skin flap of subdermal vascular plexus on repairing the raw surface of hand injury. Methods From January 1999 to June 2004, the thoracic or abdominal pedicle skin flap of subdermal vascular plexus was used to repair the raw surface of hand with defect of skin and soft tissue in 22 patients with hand injury. 17 cases were males, 5 cases were females, the ages ranged from 9 to 42. The causes of hand injury including avulsed wound in 12 cases, mangled injury in 2 cases, hot crush injury in 5 cases, electric burn in 3 cases; 13 cases needed emergency operation, 9 cases needed operation in 3 to 7 days. The thoracic or lower abdominal flap was selected depending on the raw surface of hand injury. Subcutaneous fat was trimmed and retained the thickness of 2 to 4 mm. The skin flap was designed into 2 to 3 leaves to form several pedicle skin flap of subdermal vascular plexus, which were used to repair defect of skin and soft tissue of several fingers. The defect site of skin and soft tissue of hand were put into flap. Results A little of skin flap in distal end became necrosis in 1 case after operation, but recovered fully after changing dressing to the raw surface. The rest of the flaps all survived. Follow-up was conducted 3 months to 2 years.The pedicle skin flap was living,the skin of the recipient site was smooth and integrated, color and luster was satisfactory and texture was soft.The disrupted pedicle skin flap needed no trimming. The hand function was significantly recovered. Conclusion To repair the defect of skin and soft tissue in the hand injury by using thoracic or lower abdominal pedicle skin flap of subdermal vascular plexus has the forte of shorter course of treatment and better functional recovery and good outlook. It is one of the ideals for repairing the hand injury with defect of skin and soft tissue.