保留指神经腹部袋状皮瓣治疗手部脱套伤

TREATMENT OF TOTAL AVULSION THE WHOLE HAND WITH DIGITAL NERVES PRESERVATION AND UPPER ABDOMINAL BAG-SHAPED SKIN FLAP

1983～1987年,共收治手部皮肤脱套伤4例。采取常规清创后保留或修复各指的指神经及其周围少量的脂肪组织。在对侧上腹部设计一种S形皮瓣,将皮瓣游离翻转形成袋状包裹伤手。皮肤可同时覆盖手的掌侧及背侧创面,供皮区隐蔽,张力低,切取12cm^2的皮瓣即可以拉拢闭合。由于保留了各指神经,从而有利于神经末梢长入皮瓣内。本组3例经过2～6年随访,患手的感觉、血运良好,有实物感和冷热感,功能恢复较理想。但皮瓣臃肿,需要多次分指整形。

The treatment of total avulsion of the hand is somewhat difficult and the result usually not satisfactory. Four cases of such patients were treated from 1983 to 1987. After routine debridement, digital nerves and its surrounding adipose tissue were preserved. An 'S' shape skin flap was designed an raised in the contralateral upper abdominal quadrant to cover the injured hand like a bag, so that both sides of the hand were covered. The donor area (12cm2) was directly sutured. Nerve endings might grow into the flaps because of the preservation of digital nerves. Three patients were followed-up for 2 to 6 years, the injured hands regained good pain sensation as well as stereognostic and temperatuer sensations. The function of the hand is satisfactory, but the flap looked bulky and multiple plastic operations were necessary to seperate the fingers.