套脱皮肤原位再植结合腹部分指套状皮瓣修复全手皮肤套脱伤

In situ replantaiion and cloak-like abdominal flap for repairing whole hand degloving injuries

目的探讨套脱皮肤原位再植结合腹部分指套状皮瓣修复全手皮肤套脱伤的手术方法及临床疗效。方法自2012年1月至2014年12月，对7例全手皮肤套脱伤患者，采用套脱皮肤原位再植术，术后3～10d因手指血运不佳或明确手指皮肤不能成活，再次手术切除坏死皮肤及末节指骨，采用腹部分指套状皮瓣修复5个手指，手掌、手背皮肤坏死者予植皮修复。结果术后7例均保留了5个手指，伤口均工期愈合，腹部供区伤口Ⅰ期愈合。随访时间为6～24个月，平均14个月。手掌、手背皮瓣无臃肿，皮瓣质地、厚度接近手部皮肤，手（指）皮瓣感觉恢复为S1-S2。2-5指外形圆润，不显臃肿，皮肤触痛觉恢复可，2—5指掌指关节活动度为0°-80°，2例指间关节僵直于伸直位，5例指间关节活动度0°～30°，2～5指可完成与拇指的对指、对捏等功能。供区及腹部无明显瘢痕挛缩。结论套脱皮肤原位再植结合腹部分指套状皮瓣修复全手皮肤套脱伤，弥补了原位再植无法准确判断皮肤质量的不足，可以获得较为满意的临床效果。

Objective To report the methods and clinical outcomes of treating whole hand degloving injury with replantation and cloak-like abdominal flap. Methods From January 2012 to December 2014, the whole hand degloving injury in 7 cases was treated by replantation of the degloved skin. The necrosis distal finger and skin were excised 3 to 10 days later due to insufficient blood supply of the finger or necrosis of the skin. A cloak-like abdominal flap was elevated to wrap the five digits individually. The dorsal and volar wounds were covered with full-thickness skin grafts. Results The five digits in 7 cases were all salvaged. Wounds of the hand and donor site healed well in one stage. All the patients were follow-up for 6 to 24 months with an average of 14 months. The appearance of the reconstructed hand was satisfactory. The texture and thickness of the flap were comparable to the normal hand skin. Sensation of the finger recovered to S1 to S2. The appearances of 2 to 5 digits were satisfactory without bulkiness. Range of motion of the metacarpophalangeal joint was 0° to 80°. The interphalangeal joint was stiff in extension in 2 cases, while the other 5 cases had 0° to 30°range of motion. There was reasonable opposition and pinch function. There was no scar contracture at the donor sites. Conclusion In situ replantation of degloved skin combined with cloak-like abdominal flap transfer to cover individual fingers for repairing whole hand degloving injury can achieve satisfactory clinical outcomes and make up for the inadequate judgment of the quality of the degloved skin.