本文選題：手損傷 + 脫套傷　； 參考：《蘇州大學》2015年碩士論文

【摘要】：目的:制作全手皮膚脫套傷的尸體模型,分析41例全手皮膚脫套傷臨床病例,尋找和總結全手皮膚脫套傷的傷情特點,提出全手皮膚脫套傷的臨床分型,探索新的治療方法。方法:采用6具福爾馬林浸泡及紅色乳膠灌注的成人尸體上、下肢標本各12側,在肉眼及手術顯微鏡下進行解剖及模擬操作,并制作成全手皮膚脫套傷模型�；仡櫺苑治�1999年以來我院收治的全手皮膚脫套傷病例41例,分析和總結全手皮膚脫套傷的傷情特點,提出臨床分型,并根據(jù)不同的分型制定相應的治療方案。臨床上應用帶足部皮瓣的趾甲瓣或第二趾修復全手皮膚脫套傷21例。應用吻合血管的回植術治療全手皮膚脫套傷19例。應用腹部皮瓣或瓦合皮瓣修復全手皮膚脫套傷14例。結果:臨床解剖學資料顯示,足背動脈在足背部的主要分支有跗外側動脈、外踝前動脈、跗內(nèi)側動脈、內(nèi)踝前動脈及第1跖背動脈等;可以形成以足背動脈為主干,分別以各個皮膚穿支,并攜帶足背皮瓣的姆甲皮瓣、第二趾甲皮瓣、第二趾修復全手皮膚脫套傷。根據(jù)全手皮膚脫套傷的傷情特點,將全手皮膚脫套傷根據(jù)其傷情特點分成5型,并制定相應的治療方案。臨床上應用以足背動脈為主干的皮瓣攜帶趾甲瓣修復全手皮膚脫套傷21例,其中19例獲隨訪6~36個月,修復后的全手保留2-3個手指,可以恢復手的抓捏、持物等基本功能,對足的行走無明顯影響。臨床上應用吻合血管的回植術修復全手皮膚脫套傷19例,5例完全成活者,手的屈伸、抓捏、拇指對掌等功能恢復滿意,2例完全壞死者,手功能完全喪失,其余病例均恢復部分手功能。臨床上應用腹部皮瓣或瓦合皮瓣修復全手皮膚脫套傷14例,14例均保留了5個手指,手部可以恢復基本抓持功能。結論:全手皮膚脫套傷雖然有多種方法進行修復,而要想做到既要恢復美觀的外形,又要重建良好的功能,而且對供區(qū)損傷又小,從目前的各種治療方法來看,仍沒有一個最佳的方案,但是對拇指進行單獨的修復能夠獲得相對比較滿意的療效,也是目前學者比較一致的看法。對全手皮膚脫套傷的治療要遵循以下幾點:(1)脫套皮膚完整能進行再植的要先予以再植,再植后的功能外形最好;(2)脫套皮膚毀損或缺損而無法進行再植的則予以再造加皮瓣修復;(3)拇指要進行單獨修復,并重視虎口的重建以利于功能的恢復;(4)修復后的手掌側皮膚質(zhì)地要薄,而且要有感覺;(5)再造的手指不在于多,而在于精,一般再造中(環(huán))指或中環(huán)指同時再造就能滿足患者要求;(6)要重視供區(qū)的損傷問題,供區(qū)要隱蔽,而且對供區(qū)的損傷盡量減到最小;(7)利用顯微外科方法與傳統(tǒng)的方法相結合的方法,可以有效的降低供區(qū)損傷問題。(8)要根據(jù)不同的傷情、年齡、性別、個體要求、技術水平等情況進行綜合考慮,制定個性化的手術方案。
[Abstract]:Objective: to make the cadaveric model of the whole hand skin degloving injury, analyze 41 cases of the whole hand skin degumming injury, search for and summarize the characteristics of the whole hand skin degumming injury, put forward the clinical classification of the whole hand skin degloving injury, and explore a new treatment method. Methods: six adult cadavers soaked in formalin and infused with red latex were used to dissect and simulate the operation under naked eye and operation microscope on 12 sides of lower limbs. A retrospective analysis was made on 41 cases of total hand skin degumming injury admitted in our hospital since 1999. The characteristics of the injury were analyzed and summarized, and the clinical classification was put forward, and the corresponding treatment plan was made according to the different types. 21 cases were treated with toenail flap or second toe with foot flap. Vascular anastomosis was used to treat 19 cases of whole hand skin injury. Abdominal skin flap or tile flap were used to repair 14 cases of hand skin degloving injury. Results: the main branches of dorsalis pedis artery in dorsum pedis were lateral tarsal artery, lateral anterior malleolus artery, medial tarsal artery, medial anterior malleolus artery and first dorsal metatarsal artery. The second toe was used to repair the skin loss of the whole hand with each perforating branch of the skin and the skin flap carrying the dorsal foot flap. According to the characteristics of the whole hand skin degloving injury, the whole hand skin degloving injury was divided into 5 types according to the characteristics of the injury, and the corresponding treatment scheme was established. 21 cases were treated with pedicle flap with pedicle nail flap, 19 of which were followed up for 636 months. After the repair, 2-3 fingers were retained in the whole hand, which could restore the basic functions of the hand, such as clasping and holding objects, and so on, after the repair, the skin flap with toenail flap was used to repair the skin loss of the whole hand, among which 19 cases were followed up for 636 months. There was no obvious effect on foot walking. Clinical application of vascular anastomosis in the repair of 19 cases of total hand skin removal injury 5 cases of complete survival, hand flexion and extension, clasping, thumb and other functions recovered satisfactory in 2 cases of complete necrosis of the hand, the hand function is completely lost. All the others recovered some hand function. Clinical application of abdominal skin flap or tile flap for the repair of 14 cases of total hand skin removal injury 14 cases all retained 5 fingers can restore the basic grasp of the hand function. Conclusion: although there are many methods to repair the whole hand skin degloving injury, it is necessary to restore the beautiful appearance and rebuild the good function, and the injury to the donor area is small. There is still no optimal scheme, but it is a relatively satisfactory result to repair the thumb alone, which is the consensus of scholars at present. The following points should be followed in the treatment of the whole hand skin degloving injury: (1) if the skin can be completely replanted, it should be replanted first. After replantation, the functional appearance is the best; (2) if the skin is damaged or damaged, the skin can not be replanted and then the flap is reconstructed; (3) the thumb should be repaired alone. And pay attention to the reconstruction of the tiger's mouth in order to facilitate the recovery of function; (4) the skin of the repaired palm should be thin and sensed; (5) the reconstructed fingers are not more, but more refined. In general, reengineering means (ring) or ring (ring) can meet the needs of patients at the same time; (6) attention should be paid to the injury of donor areas, which should be concealed. And the injury of donor area is minimized as far as possible. (7) the problem of donor area injury can be effectively reduced by using microsurgical method combined with traditional method. (8) according to different injury situation, age, sex, individual requirements, The technical level is considered synthetically, and the individualized operation plan is established.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R658.2

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