本文關(guān)鍵詞： 指腹 再植 游離皮瓣 再造　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 探討指腹損傷后再植及指腹缺損后再造的方法，對比各種指腹重建方法的臨床治療效果。 方法： 總結(jié)我院2004年至2014年間收治的指腹損傷或缺損的53例病例，分別采用指腹再植和六種皮瓣進行修復(fù)，其中指腹再植7例，V-Y推進皮瓣18例，帶蒂髂腹股溝皮瓣4例，指動脈逆行島狀皮瓣6例，，大魚際筋膜皮瓣5例，鄰指皮瓣11例，游離拇趾腓側(cè)皮瓣2例，并對其隨訪6～24個月，平均11個月，比較臨床效果。 結(jié)果： 53指指腹損傷及缺損的病例再植和再造完全成活51指，兩例大魚際筋膜皮瓣部分成活，經(jīng)換藥后創(chuàng)面延期愈合。術(shù)后，1例游離足拇趾腓側(cè)皮瓣、1例指動脈逆行島狀皮瓣、2例V-Y推進皮瓣出現(xiàn)靜脈或動脈危象，均給予減張?zhí)幹煤笃ぐ暄\恢復(fù)正常，繼而順利成活。隨訪時間6～24個月，平均11個月。術(shù)后6月，再植的指腹和6種皮瓣重建的指腹兩點辨別覺（χ±s)及晚期綜合療效的優(yōu)良率（%）:游離指腹再植4.61±0.27mm、100.0%，V-Y推進皮瓣5.72±0.36mm、83.3%，指動脈逆行島狀皮瓣7.22±0.32mm、83.3%，大魚際筋膜皮瓣7.52±0.45mm、80.8%，鄰指皮瓣7.44±0.42mm、81.8%，游離拇趾腓側(cè)皮瓣5.25±0.21mm、100.0%；帶蒂髂腹股溝皮瓣13.1±3.17mm、25%。 結(jié)論： ①指腹作為人體與外界接觸的敏感區(qū)，當(dāng)損傷后應(yīng)該盡量再植或完美地修復(fù)和重建。②手指指腹損傷后的修復(fù)方法很多，應(yīng)根據(jù)患者的年齡、性別、職業(yè)、供區(qū)副損傷、組織與指腹的相似度，以及術(shù)者的顯微外科技術(shù)水平進行綜合選擇。③游離足拇趾腓側(cè)皮瓣移植再造的指腹，無論從外觀、質(zhì)地、感覺還是血運上看均達到逼真的效果，應(yīng)作為指腹重建的首選方法。
[Abstract]:Objective:. To discuss the methods of replantation after finger abdominal injury and reconstruction of finger abdominal defect, and to compare the clinical effect of various reconstruction methods of finger abdomen. Methods:. From 2004 to 2014, 53 cases of finger abdominal injury or defect were treated in our hospital. Replantation of finger abdomen and six kinds of flaps were performed respectively. Among them, 7 cases were treated with V-Y advancing flap and 4 cases with pedicled ilioinguinal flap. There were 6 cases of reversed island flap of digital artery, 5 cases of great thenar fascial flap, 11 cases of adjacent finger flap and 2 cases of free fibular flap of hallux. The follow-up was 6 ~ 24 months (mean 11 months), and the clinical effect was compared. Results:. In 53 cases of finger abdominal injury and defect, 51 fingers were completely replanted and reconstructed, and 2 cases were partially survived by thenar fasciocutaneous flap. After dressing change, the wound healing was delayed. After operation, 1 case of free toe peroneal flap and 1 case of digital artery retrograde island flap and 2 cases of V-Y advancing flap appeared venous or arterial crisis, and the blood supply of the flap returned to normal after the treatment of tension reduction. The follow-up time was 6 ~ 24 months (mean 11 months). The excellent and good rate of the replanted finger abdomen and 6 kinds of flaps for the reconstruction of the two points of finger abdomen (蠂 鹵s) and the comprehensive curative effect in the late stage are as follows: the free finger replantation 4.61 鹵0.27 mm ~ 100.010. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 5 + 0. 36 mm advance flap, the island flap of the digital artery 7.22 鹵0. 32 mm 83.3, the great thenar fasciocutaneous flap 7. 52 鹵0. 45 mm, the adjacent finger flap 7. 44 鹵0. 42 mm and 81.8 mm, the free finger flap 7. 44 鹵0. 42 mm and 81.8 mm, respectively. The fibular flap was 5.25 鹵0.21 mm and the pedicled ilioinguinal flap was 13.1 鹵3.17 mm. Conclusion:. (1) the finger abdomen is a sensitive area of human body contact with the outside world. After the injury, the repair methods of finger abdomen injury should be replanted or reconstructed perfectly. 2. The repair methods should be based on the patient's age, sex, occupation and collateral injury of donor area. The similarity between tissue and finger abdomen, as well as the microsurgical technique level of the operator, were used to select 3 free toe peroneal flap graft to reconstruct the finger abdomen. The results were realistic in terms of appearance, texture, feeling and blood flow. It should be the first choice method of abdominal reconstruction.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R658.1

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