游离异形股前外侧皮瓣在手外科的临床应用

CLINICAL APPLICATION OF IRREGULAR ANTERIOR LATERAL FEMORAL FLAP IN HAND SURGERY

目的介绍一种一期修复手部不同区域、不同面积皮肤缺损的方法。方法2002年5月~2004年5月,设计不同形状的股前外侧皮瓣和股前外侧分瓣(二者组合为异形股前外侧皮瓣),修复手外科创伤中多发性多部位的皮肤缺损27例,其中男16例,女11例。左手9例,右手16例,左足2例。洞穿伤致手掌、背皮肤缺损5例,热压伤9例,齿轮伤6例,梳毛机伤5例,碾压伤致左足背、足底皮肤缺损2例,均伴有肌腱或骨、关节外露。采用“H”形皮瓣修复手掌贯穿伤5例,“Y”形或“K”形皮瓣修复手掌背伴手指皮肤缺损11例;“”形皮瓣修复手背伴手掌侧方或虎口皮肤缺损3例,足背伴足底皮肤缺损2例,“h”形皮瓣修复手背伴与之不相连的手指皮肤缺损6例。主瓣范围为6.5cm×4.8cm^17.0cm×12.0cm,分瓣为3.5cm×2.8cm^7.5cm×4.5cm。结果术后27例皮瓣全部成活,除1例筋膜瓣以外皮瓣受区伤口均期愈合,无血管危象发生。均获随访3~12个月,外形满意,皮瓣质地柔软。除2例洞穿伤、3例热压伤及1例梳毛机伤患者手功能恢复不理想,其余患者均恢复抓、捏功能,12个月以上患者恢复触、痛觉,两点辨别觉1.4~2.5cm。结论异形股前外侧皮瓣是修复手部复杂皮肤缺损较为理想的方法。

Objective To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure. Methods From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoral flap（forming irregular anterolateral femoral flap） was designed into different shapes to repair multiple soft tissue defect in different regions in hand, which was used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9 , right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hotpressing injury, 2 soft tissue defection of instep and planta by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, hones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K shape flaps in 11 cases of dorsals or combined with fingers of hand with skin defect ; with ＋-shape flaps in 3 cases of dorsals combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsals combined with palms of feet; with h shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm× 4.8 cm to 17.0 cm× 12.0 cm, the sizes of lobulate flaps ranged from 3. 5 cm× 2.8 cm to 7.5 cm× 4.5 cm. Results All flaps survived without vascular crisis after operation. Except the fascia flap all recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hotpressing injury and 1 case of carding machine injury whose function was not satisfactory, the remaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases. Conclusion The application of irregular anterolateral femoral flap is an optimal choice for complex skin defect of hand.