静脉皮瓣在复杂断指再植中的应用

Application of venous flaps in replantation of complex severed fingers

目的探讨静脉皮瓣在复杂断指再植中的应用。方法复杂断指再植16例16指,先常规行断指再植手术,患指掌、背侧皮肤缺损处应用前臂掌侧静脉皮瓣游离移植修复,同期修复血管缺损。结果 15例断指、静脉皮瓣均成活,其中3例静脉皮瓣出现部分坏死,经换药或植皮后愈合。1例术后出现静脉危象导致断指、皮瓣坏死。16例获随诊3~23个月,末次随访皮瓣外形不臃肿、质地良好。皮瓣置于患指掌侧组、背侧组的优良率比较,差异无统计学意义(χ2=0.58,P>0.05)。结论静脉皮瓣为合并血管、皮肤缺损的复杂断指再植提供了一种可行、有效的方法。

Objective To investigate the applicability and clinical effect of venous flaps in treating complex severed fingers.Methods Sixteen cases of complicated severed fingers were replanted. The routine replantation of these severed fingers was performed. The palmar and dorsal skin defects were repaired with forearm palmar vein flaps and vascular defects were repaired at the same time. Results Fifteen cases of severed fingers and venous flaps survived,three of which had partial necrosis of venous flaps but healed after dressing change or skin grafting. There was one case of venous crisis that resulted in a severed finger and flap necrosis. In three cases,only the remaining severed finger and venous flaps survived. Sixteen cases were followed up for 3 to 23 months. During the last follow-up,the flaps were not bloated and had good texture. Conclusions Venous flaps can reconstruct the blood supply of severed fingers while repairing the wound. The flaps are easy to cut,and there is less damage to the donor site. This is a feasible and effective method for the replantation of complicated fingers with vascular and skin defects.