發(fā)布時間：2018-11-03 10:20

【摘要】：目的：1、了解指端軟組織解剖特點。 2、了解V-Y推進(jìn)皮瓣、指動脈逆行島狀皮瓣、指動脈順行島狀皮瓣、筋膜皮瓣的臨床療效，為指端傷提供一個好的治療手段。 方法：臨床統(tǒng)計自2013年1月至2013年6月我們分別V-Y推進(jìn)皮瓣、指動脈逆行島狀皮瓣、指動脈順行島狀皮瓣、指背筋膜皮瓣采用4種皮瓣修復(fù)手指（包括拇指）指端皮膚缺損。患者42例46指，男31例，女11例，年齡8歲~60歲，平均40歲，其中拇指6指，食指20指，中指11指，環(huán)指6指，小指3指。皮膚缺損面積平均為10.0mm×8.5mm(5.0mm×6.0mm~12.0mm×15.0mm)。致傷原因包括爆炸傷1例、凍傷1例、切割傷15例、擠壓傷6例，重物砸傷19例。42例患者經(jīng)患指清創(chuàng)后皆伴末節(jié)指骨外露或缺損，其中伴末節(jié)指骨爪粗隆以遠(yuǎn)缺損者8指，末節(jié)指骨中份水平以遠(yuǎn)缺損者13指，末節(jié)指骨完整者15指，伴甲床、甲板部分缺損者10指。其中采用V-Y推進(jìn)皮瓣修復(fù)22指，指動脈逆行島狀皮瓣6指，指動脈順行島狀皮瓣11指，指背筋膜皮瓣7指。 按照中華醫(yī)學(xué)會手外科學(xué)會上肢部分功能評定試用標(biāo)準(zhǔn)[5]：無畸形，感覺及功能正常或基本正常為優(yōu)；輕中度畸形，感覺及運(yùn)動功能大部分正�；虿糠终榱迹换蚊黠@，感覺及功能喪失為差。 結(jié)果：術(shù)后隨訪3~6個月，皮瓣一期成活46指，其中2例出現(xiàn)指端皮瓣遠(yuǎn)端變黑變硬部分壞死。壞死指端皮瓣給予去除干癟部分，保留軟組織待肉芽組織長出后自行覆蓋創(chuàng)面。8指皮瓣出現(xiàn)顏色暗紫，腫脹明顯等靜脈危象，，經(jīng)肝素抗凝、間斷性小切口放血、抬高患肢、烤箱保暖、蒂部拆除縫線等對癥處理后，8例指端皮瓣均好轉(zhuǎn)。46例成活皮瓣質(zhì)地柔軟，外觀較好，顏色與周圍正常皮膚相近，全部恢復(fù)保護(hù)性感覺，手指功能基本正常，能勝任日常工作。按照中華醫(yī)學(xué)會手外科學(xué)會上肢部分功能評定試用標(biāo)準(zhǔn)[5]：優(yōu)：33例，良9例，差4例。 結(jié)論：V-Y推進(jìn)皮瓣、指動脈逆行島狀皮瓣、指動脈順行島狀皮瓣及指背筋膜皮瓣4種皮瓣是修復(fù)手指（包括拇指）指端皮膚缺損的較好選擇，應(yīng)根據(jù)皮膚缺損情況選擇適合的皮瓣予以修復(fù)。
[Abstract]:Objective: 1. To understand the anatomical characteristics of soft tissue at the fingertip. 2. To understand the clinical effect of V-Y advancing flap, reversed digital artery island flap, digital artery anterograde island flap and fascial flap, and to provide a good treatment for finger tip injury. Methods: from January 2013 to June 2013, the V-Y advancing flap, the reversed digital artery island flap, the digital artery anterograde island flap, and the digital artery anterograde island flap were analyzed. The skin defect of finger (including thumb) was repaired by four kinds of skin flaps. There were 42 patients with 46 fingers, 31 males and 11 females, aged from 8 to 60 years old, with an average age of 40 years. There were 6 thumbs, 20 index fingers, 11 middle fingers, 6 ring fingers and 3 little fingers. The average area of skin defect was 10.0mm 脳 8.5mm (5.0mm 脳 6.0mm~12.0mm 脳 15.0mm). The causes of injury included explosive injury in 1 case, frostbite in 1 case, incised injury in 15 cases, crush injury in 6 cases and heavy object injury in 19 cases. The distal phalangeal bone in 13 fingers, complete phalangeal bone in 15 fingers, and partial defect in nail bed and deck in 10 fingers. Among them, 22 fingers were repaired with V-Y propulsion flap, 6 fingers with reversed digital artery island flap, 11 fingers with anterograde digital artery island flap and 7 fingers with dorsal fascia flap. According to the evaluation criteria of upper limb function of the Chinese Medical Association of hand surgery [5]: no malformation, normal sensation and function or basic normal, mild to moderate malformation, most normal or partial normal sensory and motor function were good. The deformity was obvious and the loss of sensation and function was poor. Results: after 3 ~ 6 months follow up, 46 fingers survived in one stage of the flap, 2 of which showed the necrosis of the distal end of the flap. The necrotic phalanx flap was given to remove the dry part and retain the soft tissue to cover the wound after the granulation tissue grew. The skin flap of 8 fingers appeared dark purple color, swelling and obvious venous crisis. It was treated with heparin anticoagulant, intermittent small incision bleeding, raised the affected limb, After the oven was warm and the suture was removed from the pedicle, all the 8 fingertip flaps were improved. 46 cases survived the skin flap with soft texture, good appearance, similar color to the surrounding normal skin, all of them recovered the protective feeling, and the finger function was basically normal. Be able to do daily work. According to the evaluation criteria of upper limb function of the Chinese Medical Association, 33 cases were excellent, 9 cases were good and 4 cases were poor. Conclusion: the V-Y advancing flap, the reversed island flap of digital artery, the anterograde island flap of digital artery and the dorsal fasciocutaneous flap of the finger are the better choice for repairing the skin defect of finger (including thumb). The skin flap should be selected according to the condition of skin defect.
【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】：R658.2

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