中指拇化及大鱼际逆行皮瓣在手部爆炸伤中的应用

Middle Finger Pollicization and Reverse Thenar Skin Flap Transplantation in the Treatment of Explosive Injury of the Hand

目的探讨手部爆炸毁灭性损伤(又称毁损伤)的手术修复方法。方法 2007年1月～2011年10月,收治成年手部爆炸毁损伤患者19例,主要表现为拇、食、中指均受损,全部实行中指拇化联合二期大鱼际逆行皮瓣转移术治疗,连续观察近、远期疗效。结果所有手术均顺利完成,11例患者一期中指拇化后伤口愈合,余8例出现不同程度骨外露,经二期行大鱼际逆行皮瓣转移术治愈;随访3～36个月,骨骼愈合良好,移化中指外形美观,血运及感觉良好,两点分辨率(2.5 mm～3.5 mm)与健侧(2.0 mm～3.5 mm)接近,但为异位感觉,移位中指功能TAM评定,优13例,良6例。结论采用中指拇化及大鱼际逆行皮瓣转移术治疗手部爆炸毁损伤安全、可靠、有效。

Objective To explore the surgical method of repairing destructive explosive injury of the hand. Methods Nineteen adult patients with destructive explosive injuries of thumb, index and middle fingers admitted between January of 2007 and October of 2011 were treated with middle finger pollicization combined with secondary reverse thenar skin flap transplantation, and the short- and long-term therapeutic effects were observed continuously. Results All the operations were finished successfully. After the middle finger pollicization operations, 11 cases cured. But the other 8 cases were treated with secondary reverse thenar skin flap transplantation due to bone exposure of different degrees. During the follow-up of 3 - 36 months, the bone showed excellent healing and the displaced middle fingers were all in good shape, blood circulation and sensation. The two-point resolution （2.5 mm- 3.5 mm） was identical with the normal thumb （2.0 mm - 3.5 ram）. But the sensation was allachesthesia and the TAM evaluation result of the displaced middle fingers showed 13 cases were excellent and the other 6 good. Conclusion Middle finger pollicization combined with reverse thenar skin flap transplantation is a safe, effective and reliable approach to the treatment of destructive explosive injury of the hand.