腹部迟延皮瓣修复全手脱套伤11例疗效分析

Effects of delayed abdominal skin flap on repairing whole hands' avulsion injuries

目的探讨腹部迟延皮瓣修复全手脱套伤的疗效。方法 2006年6月-2015年3月,我院收治手部掌背两侧全手脱套伤患者共11例,其中机器挤压撕脱伤9例,热压伤2例。手部彻底清创后首先用1.2 mm克氏针将各指间关节固定于伸指位。将患手牵至对侧腹部较舒适位置做标记,患手包埋于腹部,利用腹部皮瓣及腹部迟延皮瓣共同修复手部掌背两侧全手脱套伤。结果 11例术后皮瓣均成活,皮瓣血运正常,耐磨性好,手部恢复部分拿捏功能,其中1例出现张力性水疱,表皮部分结痂,经换药后痂皮脱落;1例发生感染,克氏针外露,给予创面换药引流后感染得到控制,延期清创缝合。随访6～12个月,皮瓣耐磨性及手部功能均较满意。结论腹部迟延皮瓣用于修复手部掌背两侧全手脱套伤行之有效,术后手部可恢复部分拿捏功能。

Objective To discuss the repair of whole hand＇s avulsion injuries with delayed abdominal skin flap. Methods There were a total of 11 patients with whole hand＇s avulsion injuries on both sides admitted to our hospital from June 2006 to March 2015. Of the 11 cases, 9 patients had machine crush and degloving injury, 2 cases with crush and thermal injury. After complete debridement in hands, the kirschner wire（1.2 mm） was used to fix the interphalangeal joints（PIP） into a straight position, then the hands were dragged to a relatively comfortable position of lateral abdominal wall and marked, and then they were buried by the abdominal flap, both the delayed abdominal skin flap and abdominal skin flap were applied to repair whole hand＇s avulsion injuries. Results It showed that all flaps in 11 cases survived postoperatively. The blood supply in flaps was normal with good abrasion resistance, and the hands function restored including grasp and pinch partly. Of the 11 cases, 1 case presented with tension blisters and the skin formed scabs partly, while it fell off after changing the dressing, 1 case had infection with kirschner wire exposed, and the infection was controlled by giving wound dressing and drainage with delayed debridement and suture. The patients were followed up for 6-12 months with satisfying abrasion resistance in flaps and hand function. Conclusion Repairing whole hand＇s avulsion injuries with delayed abdominal skin flap is effective. Hands function can restore partly including grasp and pinch, and patients can accomplish some fine motor tasks such as writing, which is an ideal method for repairing the whole hand＇s avulsion injuries on both sides.