带旋髂浅血管蒂腹股沟骨皮瓣移位修复手部骨皮肤缺损

REPAIR OF COMPOUND SKIN AND BONE DEFECTS IN HANDS WITH PEDICLE OSTEOCUTANEOUS GROIN FLAP BASED ON SUPERFICIAL CIRCUMFLEX ILIAC VESSELS

目的探讨带旋髂浅血管蒂髂腹股沟骨皮瓣移位修复手部复合组织缺损的疗效。方法1998年2月~2004年5月,收治急诊入院的33例手部皮肤软组织缺损合并骨缺损。其中男22例,女11例。年龄19~54岁,平均24.3岁。手掌贯穿伤17例,手背部电刨伤9例,其他损伤7例。其中合并掌骨缺损23例,指骨缺损10例。皮肤缺损范围3.5cm×2.0cm^15.0cm×10.0cm;骨缺损1.5~4.2cm。清创3~7d后应用以旋髂浅动、静脉为皮瓣轴型血管蒂的骨(骨膜蒂)皮瓣进行修复,皮瓣切取范围4.0cm×2.5cm^17.0cm×11.0cm。结果术后骨皮瓣全部成活,创面期愈合31例,期愈合2例。随访4~22个月,平均8.2个月,皮瓣质地良好,外观及功能满意。骨缺损达临床愈合时间5~9周,平均7周。结论带旋髂浅血管蒂髂腹股沟骨皮瓣切取简便、血供丰富,供区隐蔽,且均能直接缝合,是修复手部复合组织缺损的一种较理想的方法。

Objective To investigate the outcome of repairing hand composite defects using pedicle osteocutaneous groin flap. Methods From February 1998 to May 2004, 33 cases of hand composite defects were repaired with pedicle osteocutaneous groin flap. There were 22 males and 11 females. The age was 19 to 54 years with an average of 24.3 years. The defect was caused by palmar penetrating injury in 17 cases, by dorsal hand crushing injury in 9 cases and by other injury in 7 cases. Twenty-three cases complicated by metacarpal defect, 10 by phalanx defect. The size of skin defect was 3.5 cm × 2. 0 cm to 15.0 cm× 10.0 cm, the size of bone defect was 1.5 to 3. 5 cm. After 3 to 7 days of primary debridement, defect was repaired by the pedicle osteocutaneous groin flap based on the superficial circumflex iliac vessels. The flap size was 4.0 cm×2.5 cm to 17.0 cm× 11.0 cm. Results All the osteocutaneous flaps survived. During the 4 to 22 months follow-up postoperatively, the texture, appearance and function of the flap were excellent and bone union was obtained in all cases after 7 to 9 weeks of operation. Conclusion The pedicle osteocutaneous groin flap is an ideal flap to repair the composite defect of the hand, with the benefit of simple procedure and reliable blood supply.