不同皮瓣修复术治疗手外伤软组织缺损的效果比较

Comparison of Different Skin Flap Repair Techniques for Traumatic Soft Tissue Defect of Hand

目的比较不同皮瓣修复术对手外伤软组织缺损患者的临床效果。方法将127例手外伤软组织缺损患者按手术方式不同分为2组:观察组63例行小型足趾游离皮瓣修复术,对照组64例行髂腹部带蒂皮瓣修复术。比较2组的手术情况(手术时间、术中出血量),皮瓣愈合情况(愈合时间、组织病理学评分),手部外形完好率及术后并发症发生率。结果观察组手术时间为(164.27±28.76)min、术中出血量为(85.64±3.62)mL、组织病理学评分为(1.73±0.69)分、手部外形完好率为98.41%,显著高于对照组的(124.39±24.31)min、(81.52±3.74)mL、(1.04±0.56)分、87.50%;观察组愈合时间为(14.57±2.62)d、术后并发症发生率为3.18%,显著低于对照组的(24.58±3.16)d、14.07%,差异均有统计学意义(P<0.05或P<0.001)。结论小型足趾游离皮瓣修复术的手术时间和术中出血量虽多于髂腹部带蒂皮瓣修复术,但有效缩短了患者的愈合时间、更好地恢复了手部外形,减少了术后并发症,治疗手外伤软组织缺损的疗效更为显著。

Objective To compare the clinical effects of different skin flap repair techniques on traumatic soft tissue defect of hand.Methods A total of 127 patients with traumatic soft tissue defect of hand were assigned to receive either small free toe flap repair(observation group,n=63)or pedicled iliac abdominal flap repair(control group,n=64).Operation time,intraoperative blood loss,healing time,histopathological score,intact hand shape rate and postoperative complications were compared between the two groups.Results Compared with control group,free toe flap repair increased operation time[(164.27±28.76)min vs(124.39±24.31)min],intraoperative blood loss[(85.64±3.62)mL vs(81.52±3.74)mL],histopathological score[(1.73±0.69)vs(1.04±0.56)]and intact hand shape rate(98.41%vs.87.50%),but decreased healing time[(14.57±2.62)d vs(24.58±3.16)d]and incidence of postoperative complications(3.18%vs 14.07%)(P<0.05 or P<0.001).Conclusion Compared with pedicled iliac abdominal flap repair,small free toe flap repair increases operation time and intraoperative blood loss,but effectively shortens healing time,promotes hand shape restoration and reduces postoperative complications.Therefore,small free toe flap repair is more effective than pedicled iliac abdominal flap repair for traumatic soft tissue defect of hand.