本文選題：外科皮瓣　切入點(diǎn)：指損傷　出處：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:探索鄰指指固有動(dòng)脈島狀皮瓣轉(zhuǎn)移橋接修復(fù)伴有指固有動(dòng)脈缺損的手指皮膚軟組織缺損的方法及療效。方法:自2005年6月至2015年5月,對(duì)我院23例伴有指固有動(dòng)脈缺損的手指皮膚軟組織缺損患者,應(yīng)用鄰指指固有動(dòng)脈島狀皮瓣轉(zhuǎn)移橋接修復(fù)。本組年齡15~58歲,平均38歲。損傷原因:熱壓傷6例,沖壓傷6例,機(jī)器碾軋傷9例,齒輪絞傷2例。損傷部位:示指近節(jié)6例,中節(jié)3例;中指近節(jié)5例,中節(jié)2例;環(huán)指近節(jié)2例,中節(jié)2例;小指近節(jié)3例。創(chuàng)面均伴有肌腱或骨外露,其中5例伴有指骨骨折,7例伴有肌腱斷裂,4例同時(shí)伴有指骨骨折及肌腱斷裂,遠(yuǎn)端指體血運(yùn)障礙。4例伴有雙側(cè)指神經(jīng)缺損,14例伴有單側(cè)指神經(jīng)缺損。創(chuàng)面面積為1.2cm×1.3cm~2.0cm×2.6cm。血管缺損的長(zhǎng)度為1.5cm~3.0cm。皮瓣切取面積為1.5cm×1.5cm~2.2cm×3.0cm。供區(qū)創(chuàng)面取全厚皮片植皮。結(jié)果:術(shù)后23例皮瓣全部存活,遠(yuǎn)端指體血運(yùn)恢復(fù),供區(qū)植皮全部存活。術(shù)后隨訪6~36個(gè)月,皮瓣質(zhì)地柔軟,顏色與患指周圍皮膚接近,無(wú)明顯臃腫,外觀滿意。患指存活良好,無(wú)明顯萎縮。依據(jù)手指屈伸功能總活動(dòng)度(TAM)系統(tǒng)評(píng)估標(biāo)準(zhǔn)評(píng)價(jià)患指主動(dòng)活動(dòng)范圍,16指TAM240°~265°,屬優(yōu);5指TAM205°~215°,屬良;2指TAM185°~190°,屬中;總優(yōu)良率91.3%。術(shù)后供區(qū)創(chuàng)面植皮11例有少許色素沉著,無(wú)明顯瘢痕攣縮及畸形,功能無(wú)明顯影響。結(jié)論:應(yīng)用鄰指島狀皮瓣修復(fù)伴指固有動(dòng)脈缺損的手指皮膚缺損,一次手術(shù)既可以完成創(chuàng)面的修復(fù),又橋接了指固有動(dòng)脈的缺損,是修復(fù)此類損傷的較理想的方法。
[Abstract]:Objective: to explore the method and effect of repairing finger skin and soft tissue defect with finger proper artery defect by island flap of adjacent finger propria artery from June 2005 to May 2015. 23 cases of finger skin and soft tissue defect with defect of digital artery were repaired with the island flap of adjacent finger proper artery. The age of this group was 1558 years old (mean 38 years). The causes of injury included hot compression injury in 6 cases and punching injury in 6 cases. There were 9 cases of mechanical crush and 2 cases of gear twisting. The site of injury was 6 cases of proximal finger, 3 cases of middle segment, 5 cases of proximal segment of middle finger, 2 cases of middle segment, 2 cases of proximal ring finger, 3 cases of proximal little finger. Among them, 5 cases were accompanied by fracture of phalangeal bone and 7 cases with rupture of tendon, 4 cases with fracture of phalangeal bone and rupture of tendon. There were 14 cases with bilateral digital nerve defect and 14 cases with bilateral digital nerve defect. The wound area was 1.2cm 脳 1.3cm~2.0cm 脳 2.6 cm, the length of vascular defect was 1.5 cm ~ 3.0cm. The area of flap was 1.5cm 脳 1.5cm~2.2cm 脳 3.0 cm. All the 23 cases of flap survived. The distal phalanx recovered and the donor skin graft survived. The skin flap was soft in texture, close to the skin around the affected finger, and had no obvious bloated appearance. There was no obvious atrophy. According to the systematic evaluation criteria of total flexion and extension of fingers, the range of active movement was assessed as TAM240 擄265 擄, TAM205 擄215 擄, TAM185 擄190 擄, the total excellent and good rate was 91.3%. There was a little pigmentation in 11 cases of grafted skin after operation. There is no obvious scar contracture and deformity, and the function is not obviously affected. Conclusion: the repair of finger skin defect with finger proper artery defect by using the adjacent finger island flap can not only complete the repair of the wound surface, but also bridge the defect of the finger proper artery. It is an ideal method to repair this kind of injury.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R658.2

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