反取皮植皮并二期腹部带蒂皮瓣修复全手皮肤脱套伤的临床效果

Application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury

目的探讨应用反取皮植皮并二期腹部带蒂皮瓣修复全手皮肤脱套伤的临床效果。方法2007年6月至2013年12月，对20例全手脱套伤应用废弃皮肤反取皮植皮并联合应用VSD负压吸引及二期腹部带蒂皮瓣修复，术后对5指活动度、力量、感觉恢复程度和综合功能4项标准，分别计分后做综合评定。评定标准：优为13—16分，良为9—12分，可为5—8分，差为4分以下。结果功能恢复优良19例，占95％。1例患者疼痛不太配合锻炼致近侧指间关节部分僵直，功能尚可，占5％。掌指关节活动度80°～90°，近指间关节活动85°～90°。6例感觉恢复S5级，14例二期腹部双向带真皮下血管网皮瓣修复感觉恢复S3级。本组随访时间2～6年，结果19例活动度均为4分，1例活动度为3分；力量：16例为4分，3例为3分，1例为2分。感觉：18例为3分，2例为2分。综合功能：18例为4分，2例为3分。结论本手术方法创伤小、不用多次分指手术，避免了虎口挛缩及关节僵硬，利于基层医院开展。

Objective To explore the application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury. Methods From June, 2007 to December, 2013, 20 cases of hand degloving injury of skin and skin graft, waste application and combined application of VSD vacuum suction and two fingers abdominal pedieled skin flap repair, postoperative fingers activity, strength, degree of sensory recovery and function of four standards, respectively. After doing comprehensive evaluation. Evaluation standard： excellent for 13- 16, good for 9-12 minutes, could be 5-8, difference of 4 points. Results Excellent functional recovery in 19 cases, accounting for 95%. In 1 patient the pain was not combined with exercise induced proximal interphalangeal joint part stiffness function can, accounted for 5%. Metacarpophalangeal joint activity of about 80 °-90 °, proximal interphalangeal joint activity of about 85 °-90 °. The 6 cases of sensory recovery grade ~, 14 cases of abdominal two- way two subdermal vascular network flap for repair of sensory recovery S3. The patients were followed up for 2-6 years, results of 19 cases of activity were 4 points, 1 case of active degree was 3, 16 cases of power： 4 points, 3 points in 3 cases, 1 case of 2 points. Feel： 18 cases was 3, 2 cases of 2 points. Function： 18 cases was 4, 2 cases of 3 points. Conclusion The operation method of small trauma, no multiple finger operation, avoids the contraeture of the first web space and joint stiffness, for basic level hospital.