超薄股前外侧皮瓣一期分指修复手掌合并多指创面的疗效

狄海萍; 邢培朋; 郑军杰; 马超; 黄万新; 刘磊; 薛继东; 郭海娜; 杨高远; 夏成德; 周超

doi:10.3760/cma.j.cn501225-20221129-00514

超薄股前外侧皮瓣一期分指修复手掌合并多指创面的疗效

doi: 10.3760/cma.j.cn501225-20221129-00514

1.
郑州市第一人民医院烧伤科，郑州　　450004
2.
常州大学生物医学工程与健康科学研究院，常州　　213164

基金项目:

河南省医学科技攻关项目 232102311126

河南省医学科技攻关计划省部共建重点项目 SBGJ202102208

详细信息

通讯作者:
夏成德，Email：2273451508@qq.com

周超，Email：zhouchao@cczu.edu.cn

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出版历程
- 收稿日期: 2022-11-29

Curative effects of ultrathin anterolateral femoral flap in one-stage split-finger repair of palmar combined with multiple finger wounds

1.
Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
2.
Institute of Biomedical Engineering and Health Sciences, Changzhou University, Changzhou 213164, China

Funds:

Henan Medical Science and Technology Research Program 232102311126

The Provincial and Ministerial Key Projects of Henan Medical Science and Technology Research Program SBGJ202102208

More Information

Corresponding author: Xia Chengde, Email: 2273451508@qq.com; Zhou Chao, Email: zhouchao@cczu.edu.cn

摘要

摘要: 目的探讨超薄股前外侧皮瓣一期分指修复手掌合并多指创面的疗效。方法采用回顾性观察性研究方法。2016年10月—2018年6月，郑州市第一人民医院收治20例符合入选标准的手掌合并多指创面患者，其中男15例、女5例，年龄18~77岁，清创后创面面积为8 cm×4 cm~17 cm×12 cm。创面采用超薄股前外侧皮瓣（9 cm×5 cm~19 cm×13 cm）修复，根据手指创面情况，一期分指，分指皮瓣长宽比为2.0∶1.0~2.5∶1.0。术中将皮瓣携带的旋股外侧动脉降支及其伴行静脉分别与受区桡动静脉端端吻合，将皮瓣携带的股前外侧皮神经与受区桡神经浅支进行桥接。14例患者皮瓣供区创面直接缝合，3例患者皮瓣供区创面采用接力旋髂浅动脉穿支皮瓣修复，3例患者皮瓣供区创面采用游离躯干中厚皮片移植覆盖。记录术后皮瓣成活情况及血管危象等并发症发生情况，皮瓣供区创面愈合情况。随访皮瓣外观，供受区瘢痕增生情况，患者对供受区术后外形及功能恢复满意情况。术后1年，测量皮瓣的两点辨别觉距离，采用中华医学会手外科学会上肢部分功能评定试用标准评价患者手部功能恢复情况。结果 17例患者术后皮瓣成活，未发生血管危象等并发症；1例患者皮瓣血运差、部分坏死，行换药+头部刃厚皮片移植14 d后创面愈合；2例患者术后皮瓣边缘出现轻度青紫，5 d后自行消失。皮瓣供区缝合口、接力皮瓣及皮片均存活良好。术后皮瓣色泽、质地与手部正常皮肤基本一致；供受区可见线状瘢痕，患者对术后供受区外形及功能恢复满意。术后1年，患者手部感觉功能恢复良好，皮瓣两点辨别觉距离为4~6 mm；患者手部功能恢复情况评定为优者18例、良者2例。结论超薄股前外侧皮瓣一期分指修复手掌合并多指创面，能明显减少患者手术次数，改善手部功能和美观度，值得在临床推广。
- 手损伤 /
- 外科皮瓣 /
- 显微外科手术 /
- 创面修复
Abstract: Objective To explore the curative effects of ultrathin anterolateral femoral flap in one-stage split-finger repair of palmar combined with multiple finger wounds. Methods A retrospective observational study was conducted. From October 2016 to June 2018, 20 patients with wounds on palms and multiple fingers who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 15 males and 5 females, aged 18 to 77 years. After debridement, the wound area was 8 cm×4 cm-17 cm×12 cm. The wound was repaired by ultrathin anterolateral femoral flap with area of 9 cm×5 cm to 19 cm×13 cm. According to the wound condition of finger, the finger division was performed in one stage, and the length-to-width ratio of the split-finger flap was 2.0:1.0-2.5:1.0. During the surgery, the descending branches of lateral circumflex femoral artery and accompanying vein of flap were anastomosed end-to-end to the radial artery and vein in the recipient area, respectively, and the anterolateral femoral cutaneous nerve of flap was bridged with the superficial branch of radial nerve in the recipient area. The wounds in the donor area of flap in 14 patients were sutured directly, the wounds in the donor area of flap in 3 patients were repaired by relay superficial iliac circumflex artery perforator flap, and the wounds in the donor area of flap in 3 patients were covered by free trunk medium-thick skin graft. The survival of flap, occurrence of vascular crisis and other complications, and healing of wounds in the donor area of flap were recorded. The appearance of flap, scar hyperplasia in the donor and recipient areas and the patients' satisfaction with the shape and function of the donor and recipient areas were followed up. In 1 year after surgery, the two-point discrimination distance of the flap was measured, and the recovery of hand function was evaluated by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results The flaps of 17 patients survived without vascular crisis or other complications after surgery. The flap of 1 patient had poor blood circulation and partial necrosis, and the wound was healed 14 days after dressing change and grafting of split-thickness skin graft from head. Two patients had mild cyanosis at the margin of flap after surgery, which disappeared spontaneously 5 days later. Incisions at donor site, relay flaps, and skin grafts of all patients survived well. After surgery, the color and texture of flap were basically the same as that of the normal skin of hand, and linear scars were observed in the donor and recipient areas. The patients were satisfied with the recovery of appearance and function of donor and recipient areas. After 1 year of follow-up, the patients' hand sensory function recovered well, the two-point discrimination distance of flap was 4-6 mm, and the recovery of hand function was evaluated as excellent in 18 cases and good in 2 cases. Conclusions The ultrathin anterolateral femoral flap in repairing the palmar combined with multiple finger wounds in one-stage split-finger can significantly reduce the number of surgeries and improve the function and beauty of the hand, so it is worthy of clinical promotion.
- Hand injuries /
- Surgical flaps /
- Microsurgery /
- Wound repair
狄海萍、邢培朋、薛继东：手术操作、数据收集、论文撰写；郑军杰、刘磊、郭海娜、杨高远：数据整理、统计学分析；马超、黄万新、夏成德、周超：研究指导、论文修改

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1 左侧超薄股前外侧皮瓣修复患者右手掌侧合并多指电烧伤创面。1A.右手创面清创前，可见创面基底瓷白，部分肌腱裸露；1B.清创后，可见拇指、示指、中指肌腱裸露；1C.设计左侧股前外侧分叶皮瓣及分指皮瓣；1D.切取的左侧超薄股前外侧分叶皮瓣；1E.分叶皮瓣一期分指移植覆盖创面术后即刻；1F、1G.分别为皮瓣移植术后1年患手掌侧、背侧，皮瓣存活良好，不臃肿；1H.皮瓣移植术后1年患指屈曲功能恢复良好

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