游离股薄肌移植重建上肢部分功能24例报告

Free functioning gracilis transfers for upper limb function reconstruction:report of 24 cases

目的总结功能性游离股薄肌移植的经验。方法对24例上肢功能障碍的患者行游离股薄肌移植,分别重建单纯屈指功能11例、屈肘及屈指功能12例,以及屈肘和伸腕功能1例,选择不同的动力神经源和供体血管进行神经及血运重建。结果 22例游离肌肉一期成活,其中21例功能有不同程度的恢复,1例功能未恢复;2例出现血管危象,经探查后挽救成活,但功能未恢复。结论游离股薄肌肌皮瓣移植进行上肢功能重建效果良好,但技术难度高,一旦出现血运危象,几乎无法挽救肌肉功能,并不推荐常规采用,只有各种原因导致上肢肌肉缺损、功能障碍严重而简单肌腱移位无法解决时,才可考虑运用功能性游离肌肉移植改善功能。

Objective To summarize the experience of the free functioning gracilis transfers（ FFGT）. Methods Totally 24 cases of upper extremity function deficits were enrolled into this study and FFGT were performed to restore finger flexion in 11 cases, elbow and finger flexion in 12 cases, and elbow flexion and wrist extension in 1 case. Different donor nerves and vessels were chosen. Results In 22 cases the muscle flaps survived. Function restoration was observed in 21 cases but not in 1 case. Thrombosis occurred and was recognized in 2 cases on the second day after operation, then the patients were returned to the operating room for revision of the anastomosis and restoration of circulation. But severe ischemic damage to the muscle led to function loss. Conclusions FFGT is reserved for patients who have sustained a major loss of skeletal musculature in the upper extremity resulting in a significant functional deficit. FFGT is a complex procedure and demands high techniques. It is vital that when anastomosis happens and severe ischemic damage to the muscle can be expected even the restoration of circulation can be done. FFGT should not be used when simpler accepted techniques are available.