甲皮瓣供区创面的处理

TREATMENT OF THE WOUND ON DONOR SITE AFTER GREAT TOE-NAIL FLAP GRAFT ING

目的 探讨提高口止母甲皮瓣供瓣区植皮成活的治疗措施。方法 1982年 6月～ 1998年 4月对 2 5 2例带趾骨片口止母甲皮瓣 ,18例单纯口止母甲皮瓣供区创面采用游离皮片覆盖 ,植皮区适当加压包扎处理。术后 2周拆线 ,对较厚的移植皮片或皮片未完全成活的则需延长包扎时间 ,避免过早下床行走。结果 共有 6 6例植皮坏死 ,其中38例需再次植皮 ,2 8例经换药愈合。在纵劈口止母趾骨髓腔面上植皮比在裸露骨膜上植皮的成活率明显提高。术后皮片的收缩使口止母趾跖内侧保留皮肤组织向跖外侧扩展 ,能覆盖整个口止母趾跖侧面。结论 采用改进口止母甲皮瓣的剥取、注意皮片切取及植皮区包扎等治疗措施后 ,提高了供足植皮的成活率。游离皮片移植应作为口止母甲皮瓣供瓣区创面修复的理想选择。

Objective To investigate the method of im proving the vitality of skin graft on donor site of the great toe-nail skin flap. Methods From June 1982 to April 1998, 252 cases of the great toe-nail flaps with piece of phalang e al bone and 18 cases of the simple great toe-nail flap were repaired with thin s kin graft and packed under proper pressure. The stitches were removed two weeks later in common situation. It should be postponed on split thickness or partial survival skin flap avoiding early mobilization. Results Six ty-six cases of sk in graft were necrotic after operation. Among them, 38 cases needed second skin grafting and 28 cases were healed after changing dressing. The survival rate of skin grafting was obviously higher on phalangeal marrow surface than on perioste um of the naked phalange. Contracture of the skin graft after operation made the retained skin flap expanding from medial side to lateral side and covered the w hole plantar surface of the great toe. Conclusion The survi val rate of the sk in graft on donor foot is improved after adopting the improved measures on takin g the flap from great toe and paying attention to skin graft planting and packin g. Free flap grafting is advocated for repairing of the wound on donor area of t he great toe nail flap.