改良的骨间后动脉逆行岛状皮瓣修复手背部热压伤的临床疗效

The clinical curative effect for wound surface of hand heatcompression injury treated by improved posterior interosseous artery reversed island flap

目的探讨改良的骨间后动脉逆行岛状皮瓣修复手背部热压伤的临床疗效。方法2010年1月-2015年9月，收治手背部热压伤患者20例，男16例，女4例；年龄18～45岁，平均32岁；左手9例，右手11例。均急诊人院二期修复。热压伤部位：手背部12例，虎口区6例，拇指背侧区2例。手背部热压伤范围3．5cm×4．5cm～7．0cm×8．0cm．均采用改良的骨间后动脉逆行岛状皮瓣修复，皮瓣切取范围4．0cm×5．0cm～8．0cm×9．0cm。皮瓣供区直接拉拢缝合或者植皮修复。术后1周逐渐开始在佩戴支具保护下行手指康复功能锻炼。所有患者均定期随访。结果术后所有患者皮瓣及皮瓣供区植皮均成活，创口I期愈合。术后20例均获得随访，随访时间3-12个月，平均6．5个月．皮瓣外形满意．质地柔软，虎口开大及各手指屈伸功能良好，按中华医学会手外科学分会上肢部分功能评定试用标准评定：优12例，良6例，可2例。结论改良的骨间后动脉逆行岛状皮瓣修复手背部热压伤术中操作简单．术后皮瓣成活率高。是一种修复手背部热压伤较理想的手术方式。

Objective To explore the clinical curative effect for wound surface of hand heatcompression injury treated by improved posrerior interosseous artery reversed island flap. Methods Between January, 2010 and September, 2015, 20 patients were treated for wound surface of hand heatcomprcssion injury. Of 20 cases, there were 16 males and 4 females, aged 18-45 years （mean, 32 years）; and the left hand was involved in 9 cases and the right hand in 11 cases. Two-stage repair was performed in 20 cases after emergency admission. The locations of heatcom- pression injury were dorsal hands in 12 cases, first webs in 6 cases, and dorsal thumb in 2 cases. The wound area of hand heatcompression injury were 4.0 cm×5.0 cm-6.0 cm×8.0 era, which were all repaired by improved interosseous dorsal artery retrograde island flap whose area were 3.5 cm×4.5 cm-7.0 cm×8.0 cm. One week after operation, fingers and thumb-index web began to promote rehabilitation functional training in the protection of orthosis. All patients were followed-up at regular intervals. Results All postoperative flap and the grafted skin at donor sites survived. Twenty patients were followed-up for 3-12 months （mean, 6.5 months）. The flaps had satisfactory appearance and soft texture. The thumb web widing and flexion and extension of the fingers were fine. According to Trial Standard Evaluation of the Upper-Limb Part Function of the Hand Surgery Association of the Chinese Medical Association, the results were excellent in 12 cases, good in 6 cases, and fair in 2 cases at 3 months after operation. Coneluslon To repair wound surface of hand heatcompression injury by improved posterior interosseous artery reversed island flap is a fairly ideal op- erative approach. The type of operations is simple in operation, has high survival rate of postoperative skin flap.