手部组织缺损修复方法的个性化路径式选择

Individual formation selection of repairing method in hand tissue defect

目的探讨手部组织缺损时如何较快地进行路径式个性化的修复方法选择。方法通过总结临床上治疗过的3559例病例，对不同情况的手部组织缺损进行分类，总体分皮肤软组织缺损和复合组织缺损两大类，而每一类又根据缺损面积、质地、缺损组织种类、是否有骨肌腱等外露情况，冉分出11种缺损类型，并相应选择出游离植皮、腹部带蒂皮瓣、游离皮瓣、微型游离皮瓣、微型游离复合组织瓣等18种可选手术方案。其中皮肤软组织缺损多采用游离或带蒂皮瓣修复，而复合组织缺损多采用游离或带蒂复合组织瓣修复，通过归纳，从而形成一条较为快捷的手术方案筛选思路。结果本组共3559例，其中吻合血管的游离组织移植802例，顺利成活787例；部分坏死8例；失败7例；成活率98．2％。带蒂的组织移植1302例，顺利成活1288；部分坏死14例；成活率98．9％；全厚植皮1455例，顺利成活1432例，部分坏死23例，成活率98．4％。本组中，共有254例获得6—36个月的随访，患者手部外观无明显臃肿，皮瓣区质地、弹性及功能满意。感觉恢复为s2～S1；两点辨别觉5—8mm。根据中华医学会手外科学会上肢部分功能评定试用标准优良率达86．7％。结论将手部组织缺损进行分类并列出相应的手术方案，可更有效的对手部组织缺损进行合理的手术方案选择和治疗。

Objective To explore how to select quickly the individual formation of repaired methods in hand tissue defects. Methods By summary of the clinical treatment of 3559 cases in hand tissue defects of different situations, the hand tissue defects were divided into two major categories of skin - soft tissue defects and composite tissue defects, each category based on the defect area, texture, defect organization type was to be select various surgical methods. We divided into 11 kinds of defect types, 18 kinds of options such asfree skin graft, abdominal pedicle flap, free flap, free miniature flap, free composite miniature flap inducting the formatial screening ideas of various efficient surgical program in accordance with the different types of defect classification. Results The group of 3559 cases in which free vascalarized tissue transplantation 802 cases, 787 cases successfully survived,partial necrosis of 8 cases, failure 7 cases, the survival rate was of 98.2%. Peduneulated tissue transplantation 1302 cases and successfully survived 1288, partial necrosis of 14 cases ,the survival rate was of 98.9%. Full thickness skin 1455 cases, 1432 cases successfully survived, partial necrosis in 23 cases, the survival rate was 98.4%. The group a total of 254 cases obtained from 6 to 36 months of follow-up, the patient had no significant bloated appearance of the hand, the flap region texture, elasticity and function were satisfactol. Sensory recovery of S2- S4 , two-point discrimination 5-8 cm. According to the Chinese Medical Association Society of Hand Surgery trial upper part of the functional assessment criteria, the excellent rate was of 86. 7%. Conclusion The classification of hand tissue defect and the repairing method lists, can be more effective reasonable surgical treatment options and treatment results of tissue defects