一期修复全手皮肤套状撕脱性损伤及重建部分手功能

One stage repair of glove avulsion and reconstruction of hand function

目的探讨组合组织移植治疗全手皮肤套状撕脱性损伤的临床应用。方法近１２年间采用下述方法一期修复全手皮肤撕脱伤２１例：（１）用双侧股前外侧皮瓣修复全手，二期作分指术；（２）趾甲皮瓣重建拇指，双侧股前外侧皮瓣瓦合修复２～５指及手掌背创面；（３）趾甲皮瓣修复拇指后，用①第二足趾再造中指，游离皮片修复手掌背创面；②第二足趾再造中指，单块股前外侧皮瓣修复手掌背创面；③双侧第二足趾再造示、中指，单侧股前外侧皮瓣修复手掌背创面；④双侧第二足趾再造示、中指，双侧股前外侧皮瓣修复手掌背侧创面。结果术后获３个月～１年以上的随访，２１例所有移植组织全部成活。趾甲皮瓣修复的拇指及足趾移植再造的手指，均恢复了触、温、痛觉，两点辨别觉在５～１５ｍｍ左右。结论用组织组合移植修复全手皮肤撕脱性损伤同时重建拇指及中指（示、中指），疗效比较满意。但此术具有一定的风险和失败率，临床应用时需慎重考虑。

Objective To discuss the clinical application of composite tissue transplantation in the management of glove avulsion of the hand. Methods One stage repair of glove avulsion of the hand was achieved in 21 cases in the past 12 years. (1) Bilateral lateral femoral flaps were used to cover the hand. Division of the fingers was performed in a second stage operation. (2) Wrap round flap was used to reconstruct the thumb, and bilateral lateral femoral flaps for coverage of the four fingers and the palm and dorsum of the hand. (3) Wrap round flap was used to reconstruct the thumb. For the rest part of the hand, there were four surgical options: free second toe transfer to reconstruct middle finger and skin graft to cover the palm and dorsum of the hand; free second toe transfer to reconstruct middle finger and lateral femoral flap to cover the palm and dorsum of the hand; bilateral free second toe transfer to reconstruct index and middle fingers and lateral femoral flap to cover the palm and dorsum of the hand; bilateral free second toe transfer to reconstruct index and middle fingers and bilateral lateral femoral flaps to cover the palm and dorsum of the hand.Results All the transplanted tissues of the 21 cases survived. After 3 months to 1 year's follow up, restoration of the sensation of touch, temperature and pain was found in thumbs reconstructed by wrap round flaps and fingers reconstructed by free toe transfer. 2 PD was about 5～15 mm. Conclusions Simutaneous reconstruction of thumb and fingers by composite tissue transplantation for treatment of glove avulsion of the hand leads to satisfactory results. The operation however, is risk taking and should be chosen with caution.