五个组织瓣组合移植修复全手脱套伤伴五指缺损

Composite transfer of five transplants for repair of total hand degloving injury combined with five digit loss

目的 探讨用双足供区 5个组织瓣的组合移植 ,修复全手脱套伤伴 5指缺损的优缺点。方法 1999年 7月 ,为 1例患者设计并应用了该新术式。 ( 1)患侧供足 :设计并切取以足背动脉为蒂的携带甲瓣的足背皮瓣 ,修复手背、虎口及重建拇指。足背动静脉与桡动静脉吻合 ,大隐静脉与头静脉吻合。切取以第一、二趾足底总动脉为蒂的第二足趾游离移植再造示指。第二足趾的桡侧趾足底固有动脉通过血管桥接与足背皮瓣的足底深支作串联吻合 ;尺侧趾足底固有动脉与另一组足内侧皮瓣的足底深支作串联吻合 ;趾静脉与足背皮瓣远端及前臂背侧浅静脉吻合。 ( 2 )健侧供足 :设计并切取以足背动脉为蒂的携带第二足趾的足内侧皮瓣 ,修复手掌、虎口及重建中指。足背动静脉与尺动静脉吻合 ,大隐静脉与前臂内侧浅静脉吻合。足背创面用中厚皮片植皮。结果 5个移植组织瓣全部成活。术后随访 2个多月 ,虎口大小基本同健侧 ,再造拇指对指、掌侧外展功能基本恢复。重建 3指的痛觉开始恢复。足部活动时无不适感。结论 该术式是修复全手脱套伤伴

Objective To introduce the procedure of composite transfer of five transplants from two feet for repair of total hand degloving injury combined with five digit loss, and discuss the advantages and disadvantages. Methods In July 1999, one case of total hand degloving injury combined with five digit loss was treated with the following procedure. (1) Ipsilateral foot: The dorsal flap of the foot along with the big toe skin nail flap based on the dorsalis pedis artery was harvested to cover the dorsum of the hand and the first web, and reconstruct the thumb. The dorsalis pedis artery and its concomitant veins were anastomosed with the radial artery and its concomitant veins, whereas the greater saphenous vein was anastomosed to the cephalic vein. The second toe pedicled with the first and second plantar metatarsal artery was taken to reconstruct the index finger. The plantar artery at the tibial side was anastomosed with the deep plantar branch of the dorsal flap in a series fashion. The plantar artery at the fibular side was anastomosed with the deep plantar branch of the medial flap from the opposite foot in a series fashion. The digital veins were drained to the superficial veins at the dorsum of the forearm via the veins of the dorsal flap in a pass through fashion. (2) Contralateral foot: The medial flap along with the second toe based on the dorsalis pedis artery were harvested to cover the palm and the first web and reconstruct the middle finger. The dorsalis pedis artery and its concomitant veins were anastomosed with the ulnar artery and its concomitant veins, whereas the greater saphenous vein was anastomosed to the superficial vein of the forearm. The defect of the donor area was closed by split thickness skin graft. Results All the five transplants survived. Follow up at two months postoperatively revealed that the first web space was as wide as the opposite side. The abduction and opposition of the thumb was near normal. There was sign of sensory recovery in the three reconstructed digits. The patient didn't complain discomfort of the donor feet. Conclusions This procedure of composite transplantation was a new and ideal method for treatment of total hand degloving injury combined with five digit loss.