掌腱膜挛缩症术后皮肤坏死及其防治

prophylaxis and treatment of postoperative necrosis in Dupuytren's Contracture

目的:探讨掌腱膜挛缩病人掌腱膜切除术后皮肤坏死的原因及其防治方法.方法:采用挛缩掌腱膜松解切除术治疗掌腱膜挛缩症38例64只手,其中采用齿状切口者18例26只手,采用直切口加'Z'字改形切口者20例38只手.结果:经1～5年(平均1年7个月)随访,61只手完全恢复伸直功能,1指轻度伸指障碍,4指的掌指关节及近侧指间关节轻度伸直障碍.采用齿状切口术后发生皮肤坏死者9/26只手,采用直切口加'Z'字改形切口未再发生1例皮肤坏死.结论:掌腱膜挛缩症术后皮肤坏死的主要原因与皮肤血运有关,而皮肤血运障碍主要与手术切口的设计有关.在掌腱膜挛缩和粘连严重的部位按长轴作直切口可以防止创缘皮肤坏死.

Objective：To discuss the causes and treatment of postoperative skin necrosis in Dupuytren＇ s Contracture. Methods： 38 cases （64 hands） were treated in our hospital. “Zigzag” incision was applied to 18 cases （26 hands） and straight-vertical incision plus “Z”-plasty was applied to 20 cases （38 hands） .Results： In the Zigzag incision group, necrosis occurred in 7 cases, while in the straight-vertical incision plus “Z”-plasty group, no skin necrosis occurred, 1to 5 years＇ follow-up（ 1 year and 7months on the average ） revealed that the extension function recovered totally in 61cases, slight extension defunction was found in l case and slight extension defunction of MP and PIP in 4 fingers. Conclusion：The major reason for skin necrosis after operation of Dupuytren＇ s contraturc is related to the blood supply of the skin, which mostly depends on the design of incision. Straight vertical incision along the contracture cord and the area of skin adhesion can prevent the skin necrosis.