目的 探讨应用游离小腿同一供区多块腓浅动脉穿支皮瓣修复手部多处热压伤狭长创面的效果观察。方法 自2019年5月至2021年11月，我们共收治了5例手部多处热压伤患者，一期清创，二期切除热压伤坏死皮肤后，残留创面13块，创面分布为示中环指创面3例、示中指创面1例、中环指创面1例，缺损面积为3。3 cm × 1。8 cm～11。8 cm ×2。8 cm，其中1例创面游离同侧小腿3块腓浅动脉穿支皮瓣修复，2例创面游离对侧小腿3块腓浅动脉穿支皮瓣修复，2例创面游离同侧小腿2块腓浅动脉穿支皮瓣修复。术中将皮瓣腓浅动脉穿支及其伴行静脉、皮下静脉与受区优势侧指动脉及皮下静脉端端吻合。皮瓣切取面积为3。5cmx2。0cm～12。0cmx3。0cm。记录皮瓣存活情况、供区愈合情况，随访观察供受区恢复情况。结果 术后皮瓣均存活良好，未发生血管危象，其中4例皮瓣供区均一期缝合，伤口 Ⅰ期愈合，仅留线性瘢痕;1例供区行腹部取皮植皮覆盖。术后愈合良好。术后随访时间为6～18个月，皮瓣色泽、质地优良，弹性良好，外形饱满。2例患者术后6个月皮瓣稍显臃肿，行皮瓣修薄整形术。小腿供区无明显瘢痕增生，外形良好，功能无影响。结论 游离小腿同一供区多块腓浅动脉穿支皮瓣修复手部多处热压伤狭长创面，具有供区损伤较小、一处供区可修复多个创面、皮瓣质地好的特点，临床效果满意。
Observation on the effect of using multiple superficial peroneal artery perforator flaps from the same donor area to repair multiple narrow and long wounds caused by thermal crush injury in the hand
Objective To explorethe effect of using multiple superficial peroneal artery perforator flaps from the same donor area to repair multiple narrow and long wounds caused by thermal crush injury in the hand.Methods From May 2019 to November 2021,a total of 5 patients with multiple thermal crush injuries in the hands were treated.After primary debridement and secondary removal of necrotic skin from the thermal crush injury,13 residual wounds were found.The distribution of wounds was as follows:3 wounds on the index,middle,ring finger,1 wound on the index,middle finger,and 1 wound on the middle,ring finger.The defect area was 3.3 cm × 1.8 cm to 11.8 cm × 2.8 cm.Among them,1 case was repaired by 3 free superficial peroneal artery perforator skin flaps on the same side of the leg,2 cases by 3 free superficial peroneal artery perforator skin flaps on the opposite side of the leg,and 2 cases by 2 free superficial peroneal artery perforator skin flaps on the same side of the leg.During the operation,the superficial peroneal artery perforating branch of the skin flap and its accompanying veins and subcutaneous veins were anastomosed with the superior digital artery and subcutaneous vein in the recipient area.The incision area of the skin flap was 3.5 cm ×2.0 cm to 12.0 cm x 3.0 cm.The survival of the skin flap and the healing of the donor site were recorded,and the recovery of the donor and recipient site was followed up.Results All the flaps survived well after surgery and no vascular crisis occurred.Among them,all 4 flap donor areas were sutured in the first stage,and the wound achieved primary healing,leaving only linear scars.One donor area underwent abdominal skin grafting for coverage.The postoperative healing was good.The postoperative follow-up period was 6 to 18 months.The skin flap had excellent color and texture,good elasticity,and a full appearance.2 patients had slightly swollen skin flaps 6 months after surgery and underwent flap thinning and plastic surgery.The donor area in lower leg had no obvious scar hyperplasia,good appearance,and no impact on function.Conclusion The multiple superficial peroneal artery perforator flaps from the same donor site are used to repair multiple narrow and long wounds caused by thermal crush injury in the hand.The flap has the characteristics of minimal damage to the donor site.The multiple wounds can be repaired in one donor site.The flap has good texture.The clinical efficacy is satisfactory.
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