三种手部创面移植皮瓣修复效果的评价

Three kinds of skin flaps for hand wound repair: an effectiveness evaluation

背景:手部软组织缺损皮瓣移植必须考虑供区、受区和完成操作的术者3方面因素,如何根据"受区修复重建好,供区破坏损失少,成活可靠,操作简单易行"的原则选择皮瓣值得探讨。目的:比较带蒂皮神经营养血管筋膜皮瓣,腹部皮瓣及游离皮瓣的修复效果,为临床选用提供参考。方法:对应用带蒂皮神经营养血管筋膜皮瓣,腹部皮瓣和游离皮瓣修复手部创面的28例患者进行随访,比较分析DASH(disablity of the arm,shoulder and hand)分数,损伤的部位,触觉压觉(Semme-Weinstein单丝法),动态和静态两点辨别觉(m2PD,s2PD),温度觉,臃肿程度和供区瘢痕挛缩程度。结果与结论:3种皮瓣的瘢痕挛缩程度,温度觉,触觉和两点辨别觉结果,差异均没有显著性意义;腹部皮瓣的DASH评分,臃肿程度,触压觉(Semmes-Weinstein单丝法)与其他两种皮瓣比较差异有显著性意义。结果表明3种皮瓣各有特点,临床选择应根据各种客观要求,不要先行臆断。

BACKGROUND：Donor site, recipient site and operator are three important factors for flap transplantation in the repair of hand soft tissue defects. Depth studies are needed on how to choose flaps according to the principle of“good reconstruction of the recipient site, little damage to the donor site, reliable survival, simple and easy operation”. OBJECTIVE：To compare the repairing effects of pedicled neurovascular fasciocutaneous flap, abdominal skin flap and free flap, thereby providing a reference for clinical choice. METHODS：Twenty-eight patients who underwent transplantation of pedicled neurovascular fasciocutaneous flap, abdominal skin flap and free flap in the repair of hand defects, respectively, were al fol ow-up to compare and analyze the disability of the arm, shoulder and hand （DASH）, injured site, touch and pressure sensation （Semme-Weinstein monofilament method）, dynamic and static two-point discrimination （m2PD, s2PD）, temperature sensation, swel ing degree, and degree of scar contracture at donor sites. RESULTS AND CONCLUSION：No significant difference in the degree of scar contracture, temperature sensation, touch sensation, and two-point discrimination was found among the three kinds of flaps, but DASH score, swel ing degree and tough and pressure sensation in the abdominal skin flap group were significantly different from those in the other two groups. These findings indicate that these three kinds of flaps have their own characteristics, and can be selected clinical y based on a variety of objective requirements.