下肢单蒂多组织瓣游离移植一期修复烧伤手畸形

FREE MULTIPLE FLAPS OF LOWER EXTREMITY FOR SEVERLY BURNED HAND RECONSTRUCTION

目的 介绍下肢单蒂多组织瓣一期修复烧伤后手部严重畸形的手术方法。 方法 2 0 0 0年 9月～2 0 0 3年 2月收治 6例 ,根据手部创伤形状和面积 ,应用以胫前血管为蒂串连小腿外侧皮瓣、足背皮瓣和第 1趾甲瓣游离移植一期再造拇指 ,同时修复虎口、大鱼际、掌腕瘢痕挛缩及软组织缺损。切取小腿外侧皮瓣范围 4 cm× 10 cm～ 7cm×10 cm;足背皮瓣为 5 cm× 10 cm～ 9cm× 12 cm。 结果 6例烧伤后严重手畸形被修复。移植的皮瓣及再造拇指均成活。术后随访时间 6周～ 1年。修复后手功能和外形满意。供区下肢行走功能无障碍。 结论 以胫前血管为蒂的小腿外侧皮瓣、足背皮瓣和第 1趾甲瓣串连游离移植 ,能一期修复烧伤后复杂的手畸形。手术方法可靠有效。

Objective To introduce the free multiple flaps of lower extremity based on the anterior tibital vascular pedicle for primary repair of the complex burned hand deformities.Methods From September 2000 to February 2003, the lateral leg flap, dosalis pedis flap and trimmed first toe based on the anterior tibial vascular pedicle were utilized to reconstruct the thumb and repair the first web, thenar, wrist or palmar scar contracture simultaneously in 6 patients. The flap size of lateral leg and dosalis pedis ranged from 4 cm×10 cm to 7 cm×10 cm and from 5 cm× 10 cm to 9 cm×12 cm, respectively.Resutls Six cases were treated and followed up for 6 weeks to 1 year. The transplanted flaps survived with satisfactory recovery in function and appearance of the burned hand. The function of donor lower extremity was not damaged. Conclusion The procedure of the free multiple flaps of lower extremity based on the anterior tibial vascular pedicle is reliable and effective for primary repair of burned hand.