55例拇手指套脱伤再造术疗效评价

Outcomes analysis of reconstruction of degloving injuries of the thumb and fingers in 55 cases

目的 比较和评价两种修复拇、手指皮肤套状撕脱伤的临床疗效.方法 我院自2003年7月至2013年11月治疗拇、手指皮肤套状撕脱伤患者55例.根据治疗方法不同,分为第二趾甲皮瓣修复组（40例51指）,足部瓦合皮瓣修复组（15例15指）.术后对患者再造手的客观功能、主观感受、供区足部整体功能进行评定,分析疗效.结果 第二趾甲皮瓣组40例,采用中华医学会手外科学会拇、手指再造评定标准评定优23例、良17例,Michigan手功能评价平均分73.08,Maryland足部评分标准评定优5例、良33例、可2例;足部瓦合皮瓣组15例,采用中华医学会手外科学会拇、手指再造评定标准评定优15例,Michigan手功能评价平均分84.33,Maryland足部评分标准评定优13例、良2例.结论 第二趾甲皮瓣及瓦合皮瓣两种术式修复拇手指套脱伤均能取得较好的临床疗效,但瓦合皮瓣修复组临床疗效更好,足部供区损伤更小,患者满意度更高.

Objective To compare and evaluate the clinical results of two approaches of treating thumb and finger degloving injuries.Methods From July 2003 to November 2013,55 patients with thumb and finger degloving injuries were treated with two different approaches,the second toe wrap-around flap for 51 fingers in 40 cases and the combined dorsalis pedis flaps in for 5 thumbs and 10 fingers in 15 cases.Postoperatively the functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,the Michigan Hand Outcome Questionnaire （MHQ） and the Maryland Foot Score were used to evaluate the overall outcomes of the repaired hand and the donor sites.Results In the second toe wrap-around flap group,the results were rated as excellent in 23 cases and good in 17 cases by the Chinese Medical Association Hand Surgery Society criteria.The MHQ score was 73.08 on average.The donor site results assessed by the Maryland foot score were excellent in 5 cases,good in 33 cases and fair in 2 cases.In the combined flaps group,the functional results in all 15 cases were rated as excellent by the Chinese Medical Association Hand Surgery Society criteria.The MHQ score averaged 84.33.The donor site results assessed by the Maryland foot score were excellent in 13 cases and good in 2 cases.Conclusion Both the second toe wrap-around flap and combined dorsalis pedis flap approaches can achieve satisfactory results in repairing degloving injuries of the thumb and fingers.The combined flap procedure has better outcomes,less donor site morbidity and higher patient satisfaction.