游离股前外侧Flow-through皮瓣在手部复杂性断指再植创面修复中的应用
Application of free anterolateral femoral Flow-through flap in the repair of complicated replantation wound of severed finger of hand
周福成 1何智阔 1吕永源 1赵胡瑞1
作者信息
- 1. 新疆维吾尔自治区第三人民医院手足显微外科,新疆维吾尔自治区乌鲁木齐 830000
- 折叠
摘要
目的 探讨游离股前外侧Flow-through皮瓣在手部复杂性断指再植创面修复中的临床应用及疗效.方法 2016年5月-2022年11月,应用股前外侧Flow-through皮瓣急诊修复15例手部复杂性断指再植创面.通过旋股外侧降支动脉主干或穿支串联断指,完成复杂性断指血运重建,其中皮肤软组织缺损面积:7.0 cm×8.0 cm～12.0 cm×23.0 cm,主干血管缺损长度3.5～10.0 cm,对于合并血管、神经或肌腱缺损者,行血管移植、神经移植或携带阔筋膜张肌重建,合并手部死腔嵌合穿支肌皮瓣移植修复,术后门诊或微信随访分析患指及皮瓣情况评估并指导锻炼.结果 除1例断指再植坏死,其余皮瓣及断指再植全部成活.患者均获得随访,随访时间6～24个月,断指及皮瓣成活质量良好,皮瓣厚度与周围皮肤接近,质地柔软,无严重瘢痕,恢复部分保护性感觉;断指指体轻度萎缩,恢复指体外形,功能恢复满意,两点辨别觉达5～11 mm;末次随访时根据中华医学会手外科学会上肢部分功能评定试用标准评定再植指功能:优3例,良9例,可2例,差1例,优良率达80％.结论 应用游离股前外侧Flow-through皮瓣急诊修复手部复杂性断指再植创面,利用旋股外侧动脉降支或分支与缺损的主干动脉桥接,实现了重建远端血液循环及覆盖创面的双重功能,明显缩短手术时间,提高皮瓣及指体血运重建率,效果良好,值得临床推广.
Abstract
Objective To investigate the clinical application and efficacy of free anterolateral femoral Flow-through flap in the repair of complicated replantation wound of severed finger of hand.Methods From May 2016 to November 2022,15 cases of complicated hand amputation wounds were repaired by anterolateral femoral Flow-through flap.The complex severed finger was reconstructed by connecting the main or perforating branch of the descending branch of the lateral flexor femoral artery in series.The skin and soft tissue defects were about:7.0 cm×8.0 cm～12.0 cm×23.0 cm,the length of main vessel defect is about 3.5cm-10cm.For patients with vascular,nerve or tendon defects,vascular and nerve transplantation or tensor fascia lata reconstruction should be carried out,combined with the transplantation and repair of hand dead Mosaic perforator myocutaneous flap.Postoperative outpatient or wechat follow-up analysis should be conducted to analyze the affected finger and the flap condition and to evaluate and guide exercise.Results All skin flaps and finger replantation survived except 1 case.All patients were followed up for 6-24 months.The severed fingers and flaps had good survival quality,the thickness of the flaps was close to the surrounding skin,the skin flap was soft,no serious scar was found,and part of the protective feeling was restored.The broken finger body was slightly atrophic,the shape of the finger body was restored,the function was restored satisfactorily,and the sense of two-point discrimination reached 5～11 mm;At the last follow-up,the function of retransplanted finger was evaluated according to the trial standard of upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association:excellent in 3 cases,good in 9 cases,fair in 2 cases,poor in 1 case,with an excellent and good rate of 80％.Conclusion Free application of anterolateral femoral Flow-through flap in emergency repair of complex severed finger regrafting wound of hand,using descending branch or branch of rotatory femoral lateral artery to bridge with the defect of main artery,realizes the dual functions of rebuilding the distal blood circulation and covering the wound,significantly shortens the operation time,improved the reconstruction rate of skin flap and finger body blood circulation,and the effect is good,worthy of promotion.
关键词
Flow-through皮瓣/股前外侧皮瓣/断指再植/修复Key words
Flow-through flap/Anterolateral femoral flap/Replantation of severed finger/Repair引用本文复制引用
出版年
2024
NETL
NSTL
万方数据