急诊游离组织移植在手足毁损伤中的应用

Application of early repair with free tissue transplantation in hand and foot destructive injury

目的探讨手足毁损伤保肢治疗的方法，明确急诊游离组织移植在手足毁损伤保肢治疗中的作用。方法回顾2015年1月-2016年1月手、足部毁损伤并且保肢治疗共17例．采用游离股前外侧皮瓣、游离腓骨皮瓣和动脉化静脉皮瓣等游离移植修复其皮肤软组织及骨质缺损。术后随访12个月．对治疗后外观、功能进行评分．手部评分标准为中华医学会手外科学会上肢功能评定标准．足部功能评分标准为Maryland足部评分系统。结果17例手术后皮瓣全部成活，1例皮瓣术后出现血管危象。行血管探查后皮瓣成活良好，1例皮瓣术后出现感染，多次清创后伤口愈合。术后12个月时上肢功能评分优2例、良2例、中1例，下肢优3例，良3例，中2例，差4例。结论急诊游离组织移植可以最大程度的保存肢体长度，可以覆盖外露骨、肌腱，并提高抗感染能力，进而提高手足部毁损伤保肢治疗后的功能及患者的满意度。

Objective To explore the method of limb salvage therapy for hand and foot destructive injury, and to clarify the role of free tissue transplantation in limb salvage therapy in patients with hand and foot destructive injury. Methods From January, 2015 to January, 2016, 17 hand and foot destructive injuried patients were treated with limb salvage. The anterolateral thigh free flap, free fibular flap and arterial vein flap were used to repair the skin, soft tissue and bone defects. All patients were followed-up for 12 months. The appearance and function of the patients were evalu- ated after the treatment. The hand scoring criterion was the finger replantation function evaluation standard on probation of the Chinese Medical Association of Hand Surgery. The foot scoring criterion was the Maryland score system. Re- suits All flaps survived in 17 patients. One flap had vascular crisis after operation, and survived after vascular ex- ploratory operation. One case had infection postoperation and healed after several debridements. After 12 months, the functional scores were excellent in 5 cases, good in 5 cases, moderate in 3 cases and poor in 4 eases. Conclusion The early repair with free tissue transplantation can preserve limb length, cover the exposed bone and tendon, and improve the anti - infective ability, so as to improve the function of limb salvage and patient ＇s satisfaction.