上肢微型游离皮瓣移植修复手指创面

Upper limb free mini-flap transplantation for repair of finger wounds

背景:目前临床上治疗手指创面的手术方法有局部筋膜蒂皮瓣转位、足部及上肢微型游离皮瓣转位等。目的:探讨上肢微型游离皮瓣修复各种外伤所致手指创面的手术方法及近期疗效。方法:2010年12月至2014年2月,广西医科大学第一附属医院创伤骨科手外科收治的12例手部创面患者,共12指,均为不规则创面,伴不同程度骨骼及肌腱外露;创面范围为(1.5 cm×2.0 cm)-(3.0 cm×4.5 cm)。12例均先行创面清创处理,之后采用四肢微型游离皮瓣修复创面;供区直接缝合。结果与结论:全部12例皮瓣均成活,供区及受区切口皆Ⅰ期愈合。患者均获随访,随访时间3-6个月,平均4.5个月。皮瓣外观良好,无需再次行皮瓣修整,患指功能及外观恢复较理想。根据中华医学会手外科学会上肢部分功能评定试用标准评定患指修复后活动功能显示,优3例,良8例,差1例;优良率为91%。结果证实,上肢微型游离皮瓣是修复手部创面的理想方法,具有对手部正常组织无损伤及供区隐蔽等优点,近期疗效好。

BACKGROUND： Recently, the clinical repair methods of irregular wound on fingers primarily include local pedicled flap and free mini-flap of upper extremities or lower extremities. OBJECTIVE： To discuss the application of free mini-flap derived from upper limb in repairing the wound on fingers. METHODS： From December 2010 to February 2014, 12 patients with irregular wounds on 12 fingers were selected from Department of Traumatic Orthopaedics and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, China. The size of wounds ranged from 1.5 cm ~ 2.0 cm to 3.0 cmx 4.5 cm with different degrees of bone or tendon exposure. After the debridement, 12 patients were treated by free mini-flaps of upper limb. The donor sites were directly sutured. RESULTS AND CONCLUSION： Among the 12 patients, all the wounds at recipient and donor sites were healed at stage I, and the free mini-flags survival completely. All of patients were followed up for 3-6 months （average 4.5 months）. Free mini-flags had good appearance and needn＇t undergo secondary trimming. The active motion of fingers was improved dominantly. According to the criteria of Hand Surgery Association Society of Chinese Medical Association Society for the function evaluation of upper limb, three cases were excellent, eight were good and only one was bad. The excellent and good rate was 91%. Free mini-flaps of upper limb are an ideal method for repair of wounds on fingers. It has no injury to normal tissue in hands, donor site is very secluded, and the short-term curative effect is good.