下腹部多个真皮下血管网皮瓣在手外伤修复中的应用

Treatment of hand injuries by subcutaneous vascular net flaps from the lower abdomen

目的:应用下腹部多个真皮下血管网皮瓣修复手外伤。方法:在下腹部形成以旋髂浅血管为蒂的髂腰部皮瓣及以腹壁浅血管为蒂的下腹部皮瓣,二皮瓣共蒂形成双叶皮瓣,同时将其修薄,形成有轴心血管的真皮下血管网皮瓣,修复两指完全脱套伤。在下腹部形成多个真皮下血管网的任意皮瓣,修复多个指背皮肤缺损伴有肌腱及骨外露的创面。供区如不能直接拉拢缝合,可取断层皮片修复供区创面。结果:本组10例中,8例采用下腹部双叶真皮下血管网轴型皮瓣修复,2例采用下腹部真皮下血管网任意皮瓣修复,术后效果满意。结论:采用多个真皮下血管网皮瓣修复手外伤的创面,伤指不需并指、去脂、分指、术后外形佳,是目前较理想的修复手外伤的手术方法。

Objective: To investigate the application of subcutaneous vascular net flaps from the lower abdomen in the treatment of hand injuries. Methods: Lower abdominal flaps were formed by using iliolumbar flaps with the superficial iliac and superficial epigastric blood vessels as the pedicles. They were co - pedicled and bilobate flaps, which were cut thin to form subcutaneous vascular net flaps with axis blood vessels. The flaps were used to repair complete dismantled injuries of two fingers. Several random subcutaneous vascular net flaps were formed in the lower abdomen to repair the nail skin damages on several fingers with surface wounds accompanied by exposures of muscle tendons and bones. The donor area which could not be sutured directly were repaired by segmented grafts. Results: Eight out of our 10 patients were satisfactorily treated with lower abdominal bilobate axis flaps and the other two with lower abdominal random subcutaneous vascular net flaps. Conclusions: The application of several subcutaneous vascular net flaps is, so far, the best management of the surface of a hand wound, which does not require syn-dactyly, depletion or separation of the injured finger.