四、五块游离组织组合移植一期手再造

Primary hand reconstruction with combined transfer of 4 or 5 free tissues

目的 探讨用4块或5块游离组织组合移植再造手的功能和效果。方法 对12例手缺损患者用6种术式急诊或亚急诊进行手再造。4块游离组织组合移植者用5种术式,5块游离组织组合移植用1种术式,即拇指用(足母)甲瓣或趾腹皮瓣修复,双侧第二足趾再造示、中指或中、环指,2块游离皮瓣覆盖手掌和(或)手背创面。结果 12例中除1例发生1块足外侧皮瓣坏死外,余全部存活。术后随访1～6年,12例的拇指均恢复和其它再造指的对捏功能,并能自理日常生活。结论 多块组织组合移植手术是一个庞大的工程,切取的供区多,创伤大,技术要求高,风险也大。在目前异体手再植及假肢技术尚不完善的情况下,对严重手创伤仍为最佳的修复方法。

Objective To investigate the function and outcomes of the reconstructed hand with combined transfer of 4 or 5 free tissues. Methods Twelve patients with hand defect were involved in this study. All damaged hands were reconstructed with 6 procedures emergently or sub-emergently. Five different procedures were designed for 4 free tissues combined transfer and 1 procedure for 5 free tissues combined transfer. That was, wraparound flap or free plantar flap from the great toe was used for thumb reconstruction, index and middle fingers or middle and ring fingers were reconstituted with transfer of bilateral second toes, and the hand skin defect at the palmar and/or dorsal side was covered with 2 free flaps. Results All free tissues survived except necrosis of foot lateral flap in 1 case. Over a period of 1-6 years follow-up, pinch function between the reconstructed thumb and fingers was restored satisfactorily in 12 cases. The patients had a normal activity of daily life. Conclusion The demanding procedures of combined multi-free-tissues transfer has following characteristics: sufficient donor site, great trauma, requirement of skillful technique and great potential of loss. However, we argue that it is still an optimal procedure for severe hand injury, as there is no significant improvement in hand allografting and artificial hand.