手多元组织缺损的一期显微修复

PRIMARY MICROSURGICAL REPAIR OF MULTISTRUCTURAL DEFECTS OF HAND

手部多元组织缺损的一期修复与功能重建较为困难。采用口止母甲瓣或第二足趾与皮瓣组合移植修复手桡、尺侧手指及皮肤缺损，多指缺失，全手皮肤及手指缺损４８例，应用１０４个游离组织瓣全部成活。经５个月～６年随访，再造手指功能良好，两点辨别觉为４ｍｍ～１２ｍｍ。有１０例二期行皮瓣整形和肌腱松解术。认为，组合组织移植一期修复手部多元组织缺损，有恢复期短、功能恢复快的优点。

Fortyeight cases of multistructural defects of hands were primarily repaired or reconstructed from July 1989 to 1997. The structural defects included: the defects of radial or ulnar aspect of hands involving fingers and skin, multiple fingers defects and the fingers and skin defects of whole hand. In this series, there were 32 males and 16 females with age ranged from 17 to 46 years old. The composite tissue grafts were obtained from wraparound flap or 2nd toe skin flap of the foot. The result showed that composite 108 tissues transplantations, or 48 cases, were all survived. Affer a follow-up of 38.5 months (ranged from 5 months to 6 years), the grasp, pinch and opposition function of the reconstructed finger were restored, the two-point discrimination sensation was 4mm～12mm. Most of the patients had resumed their original works. So that the primary repair of multistructural defects of hands by composite tissues transplantation was feasible and valuable, but thorough debridement and skilled microsurgecal technique were required.