预制岛状皮瓣修复手足大面积软组织缺损

Repairation soft tissue defects of hand and foot with prefabricated island flaps

目的探讨修复手足大面积软组织缺损的方法及临床效果。方法彻底清创后,测量出软组织缺损面积,然后在腹部或小腿后部设计可供转移的岛状皮瓣,画出其正常范围,再根据缺损面积放大,皮瓣远端放大5～10cm;切取时,先解剖、游离皮瓣远2/3部分并彻底止血,在深筋膜下放置硅胶囊或乳胶手套阻隔,皮瓣原位缝合;1周后局麻下解剖皮瓣近1/3部分,放置阻隔物并原位缝合;2～3周后解剖蒂部并切取整块皮瓣转移至受区,供区游离植皮。结果临床应用12例,1例皮瓣远端约1cm皮肤坏死,换药后愈合,其余11例全部成活,创面得到了良好覆盖,保住了肢体。结论在手足大面积软组织缺损修复中,预制岛状皮瓣是一种实用、经济的好方法。

Objective To explore the way to repair large foot and its clinical effect. Methods Of the 12 patients, area defects of soft tissue on hand and complete debridement was done firstly, then the area of soft tissue was measured. Island flap that can be transferred was designed on abdomen or back of the calf, the normal outline of the flap was drawn and the distal outline was magnified 5cm to 10cm according to the defect area. The distal 2/3 flap was anatomized and dissociated, completely hemostasised, and then was sutured in situ after placing silicon capsule or latex glove under the deep fascia. One week later, the proximal 1/3 flap was also anatomized and sutured in situ after placement of separator. 2-3 weeks later, the pedicel was anatomized, the whole flap was resected and transferred to receptive region, and free skin was grafted on donor site. Resuits Among the 12 cases, one had 1cm skin necrosis on the distal of the flap, which was healed after dressing. The other flaps were survived, the wound were covered well, and the limbs were saved.Conclusion Prefabricated island flap is an useful and economic approach on the repairment of large area defects of soft tissue on hand and foot.