手掌毁损的修复与重建

Repairation and reconstruction of destructive palm

目的 研究毁损手掌外形与功能重建。 方法 按照手掌和手指的毁损程度采用两类方法修复 ,对毁损性断掌用 4种异位再植的办法 :(1) 2个离断手指连同部分手掌移位再植于前臂残端 ;(2 ) 2个或 3个断手指连同部分手掌再植于腕部 ;(3) 5个断指连同部分手掌全部移位再植于前臂残端 ;(4 )将部分手掌改建 ,断手指移位再植。对手掌手指全部或部分的毁坏 ,主要根据手功能恢复的要求 ,采用从足部切取相应的组织如足趾、第一趾蹼、跖骨、足背皮瓣等移植修复 ,因上述组织都是足背动脉及其分支供应 ,静脉回流也主要依靠大隐静脉系统 ,手术时可以整体切取 ,一期移植重建手术共 82例。 结果 除 1例再植断指部分坏死外 ,其余全部成功 ,手的外形与功能均得到较好改善与恢复。 结论 手掌毁损通过移位再植和组织移植重建 。

Objective To study the repairation of the appearance and reconstruction of the function to the destructive palm Method Two methods were adopted according to the destructive extent of palm and finger The destructive severed palm can be ectopicaly replanted by four kinds of ways:(1) 2 severed fingers and partial palm were ectopicaly replanted to the end of the forearm (2) 2 or 3 severed fingers and partial palm were replanted to the wrist (3) 5 fingers and partial plam were replanted to the end of the forearm (4)The partial palm was reconstructed and the severed fingers were ectopicaly replanted For the cases suffered from complete or partial destructive palm injury,the corresponding tissues from the foot such as toe,first web,metatarsal bones or dorsal flap were transplanted according to the needs of hand reconstruction Since the blood supply and return system mainly depends on dorsal artery of foot and great saphenous vein,the entire resection and transplantation can be done at one stage in all cases Result All the cases gained success except one finger with partial necrosis Good recovery of appearance and function of hand were obtained Conclusion The destructive palm can be reconstructed by ectopic replantation and tissue transplantation The function and appearance of hand can be improved