腹部两层皮下组织瓣在手部复杂损伤晚期修复中的应用

The usage of abdominal double layer subcutaneous flap in repairing late complicated hand injury

目的介绍利用腹部两层皮下组织瓣晚期修复手部复杂损伤的手术方法、适应证。方法自1998年10月以来,设计了腹部两层皮下组织瓣移植,并将该方法应用于手部复杂损伤的修复,共实施了16例手术。结果16例患者随访时间3～24个月,平均13个月。所有患者术后皮瓣愈合好,没有出现并发症。经理疗,肌腱活动度恢复的优良率(TAM法)达到80%,所有患者均无再次手术的要求。结论腹部两层皮下组织瓣主要用于手部复杂损伤的晚期修复,尤其适用于合并骨折不愈合,肌腱、神经缺损或肌腱粘连等情况的病例。该手术的最大优点是不仅为局部提供了良好的皮肤覆盖,也为肌腱、神经等组织提供了良好的基床,同时还为骨和肌腱的愈合提供了良好的软组织条件。

Objective To introduce the method, indications and the usage of abdominal double layer subcutaneous flap for the repair of late complicated hand injury. Methods A new type of flap was designed to repair the complicated hand injury. Sixteen cases were treated with this method since 1998. Results The duration of the follow up ranged from 3 to 24 months with an average of 13 months. All of the flaps survived well. After physiotherapy, the overall excellent and good rate of joint movement was 80%(TAM standard). No further surgery was required in all of the cases. Conclusion The abdominal double layer subcutaneous flap was especially indicated in those cases with bone nonunion, tendon and nerve defect and tendonous adhesions. This kind of flap not only provide a good skin covering, but also offer a soft bed for the tendons, nerves, and bones.