摘要
目的 介绍应用游离足背复合组织瓣修复重建手背复合软组织缺损的方法.方法 2015年6月-2021年6月,对13例手背复合神经肌腱皮肤缺损的患者采用游离足背复合组织瓣重建患手伸指、感觉功能.皮瓣切取面积:6.0 cm×4.0 cm～8.0 cm×5.5 cm,肌腱移植长度4.0～7.5 cm,肌腱移植数目1～4根,供区全厚皮片植皮加压包扎.结果 术后13例皮瓣全部成活,经6～24个月的随访(平均13个月),皮瓣外观良好,无臃肿,质地佳,两点辨别觉为9～13 mm,患手重建伸指功能恢复良好,根据手指主动活动度(Total active movement,TAM)评价法,优良率达75％,患者较满意.供区植皮处稍有色素沉着,行走无影响,1例植皮部分坏死,经换药后瘢痕愈合;1例供区一期VSD覆盖,二期植皮.结论 游离足背复合组织瓣修复手部复合软组织缺损,能很好地覆盖创面的同时通过携带肌腱神经重建伸指以及感觉功能,是一种较为理想的治疗方法.
Abstract
Objective To explore the method of repairing the soft tissue defect of hand by using free foot dorsal composite tissue flap.Methods From June 2015 to June 2021,13 patients with hand dorsal complex soft tissue defect were reconstructed with free foot dorsal flap for finger extension and sensory reconstruction.The donor area of the flap was 6.0 cm×4.0 cm～8.0 cm×5.5 cm.The length of tendon transplantation ranged from 4.0 to 7.5 cm,and the number of tendon transplantation ranged from 1 to 4.Pressure dressing of the donor site for whole thickness skin graft.Results All 13 cases survived well.After 6 months to 2 years of follow-up(average of 13 months),the skin flap shows good appearance,no overgrowth and had good texture.The two-point dicrimination was 9～13 mm.According to the evaluation method of total active movement(TAM),the excellent and good rate was up to 75％.There was little hyperpigmentation at the skin graft site in the donor area,and there was no effect on walking.One case had partial skin necrosis and healed after dressing change,and one case had primary VSD covering on the wound surface,and the skin graft survived completely.Conclusion The repair of hand combined tissue flap can not only cover the wound but also carry the tendon reconstruction of extensor function bridging nerve defect,which is an ideal treatment method for the repair of hand dorsal complex tissue defect.
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