足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面的疗效

薛继东; 狄海萍; 梁琰; 邢培朋; 郭海娜; 赵孝开; 王丽敏; 夏成德

doi:10.3760/cma.j.cn501225-20230323-00094

足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面的疗效

doi: 10.3760/cma.j.cn501225-20230323-00094

郑州市第一人民医院烧伤科，郑州　　450004

基金项目:

河南省医学科技攻关计划省部共建重点项目 SBGJ202002126, SBGJ202102208

详细信息

通讯作者:
夏成德，Email：2273451508@qq.com

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出版历程
- 收稿日期: 2023-03-23

Curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China

Funds:

The Joint Project of Henan Medical Science and Technology Research Program of China SBGJ202002126, SBGJ202102208

More Information

Corresponding author: Xia Chengde, Email: 2273451508@qq.com

摘要

摘要: 目的探讨采用足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面的疗效。方法采用回顾性观察性研究方法。2017年7月—2022年2月，郑州市第一人民医院收治20例符合入选标准的手指Ⅳ度电烧伤患者，其中男19例、女1例，年龄18~64岁。20处创面中，15处创面位于掌侧，包括拇指8处、示指5处、中指2处；5处创面位于背侧，包括示指1处、中指4处。清创后创面面积为4.5 cm×2.0 cm~7.0 cm×3.0 cm。根据组织结构相似性原则，采用足底内侧皮瓣修复10处创面、采用拇趾腓侧皮瓣修复5处创面、采用足背动脉皮瓣修复5处创面，皮瓣切取面积为5.0 cm×2.5 cm~8.0 cm×3.5 cm。游离移植皮瓣且同时吻合动静脉和/或神经，移植大腿中厚皮修复供区创面。术后观察皮瓣和皮片成活情况。随访观察皮瓣外观以及患指末梢温度、颜色。于末次随访时，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估患指关节功能及皮瓣感觉恢复情况，测量吻合神经皮瓣处皮肤两点辨别觉距离；采用疗效满意度评分表调查患者的疗效满意度，并计算非常满意率；采用综合评价量表评价皮瓣修复效果，并计算优良率。结果术后皮瓣和皮片均成活。术后随访10~18个月，皮瓣外观自然、不臃肿，患指末梢温度、颜色与正常手指皮肤基本一致。末次随访时，患指关节功能恢复情况：11个患指关节活动度在正常范围，6个患指总主动活动度恢复到健侧的85%，3个患指总主动活动度恢复到健侧的75%。皮瓣感觉恢复情况：吻合神经的15个皮瓣感觉均恢复到S3 ⁺级，皮瓣处皮肤两点辨别觉距离为7.0~9.0 mm；未吻合神经的有1个皮瓣感觉恢复到S2级，4个皮瓣感觉恢复到S1级。20例患者的疗效满意度：非常满意者16例、一般满意者4例，非常满意率为80%；20个皮瓣修复效果：优16个、良2个、中2个，优良率为90%。结论由于供受区组织结构相似，采用足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面可获得较佳的外观和功能，其中行神经吻合者患指功能及感觉恢复更佳，患者疗效满意度高，值得推广。
- 烧伤，电 /
- 指损伤 /
- 外科皮瓣 /
- 显微外科手术 /
- 创面修复
Abstract: Objective To explore the curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers. Methods A retrospective observational study was conducted. From July 2017 to February 2022, 20 patients with full-thickness electric burn wounds deep to tendon or even bone in fingers who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 19 males and 1 female, aged 18 to 64 years. Among the 20 wounds, 15 wounds were located on the palm side, including 8 on the thumb, 5 on the index finger, and 2 on the middle finger; 5 wounds were located on the back, including 1 on the index finger and 4 on the middle finger. After debridement, the wound area ranged from 4.5 cm×2.0 cm to 7.0 cm×3.0 cm. According to the principle of tissue structure similarity, 10 wounds were repaired with plantar medial flaps, 5 wounds were repaired with hallux peroneal flaps, and 5 wounds were repaired with dorsalis pedis artery flaps, with flap area of 5.0 cm×2.5 cm-8.0 cm×3.5 cm. The flaps were transplanted freely and arteries and veins and/or nerves were anastomosed at the same time. The wound in the donor site was repaired with thigh medium-thick skin graft. The survival of flaps and skin grafts were observed after surgery. The appearance of flap, temperature and color of the distal end in the affected finger were observed during follow-up. At the last follow-up, the joint function and flap sensory recovery of the affected finger were evaluated with the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; the two-point discrimination distance of skin in the area of flaps with nerve anastomosis was measured; the satisfaction of patients with the curative effect was investigated by using the curative effect satisfaction rating scale, and the very satisfied rate was calculated; the repair effect of flap was evaluated by the comprehensive evaluation scale, and the excellent and good rate was calculated. Results All the flaps and skin grafts survived after surgery. During the follow-up of 10-18 months after surgery, the appearance of flap was natural and not bloated; the temperature and color of the distal end in the affected finger were basically the same as that of normal finger skin. At the last follow-up, the function recovery of the affected finger joints was as follows: 11 affected fingers were within the normal range of motion, 6 affected fingers had their total active range of motion recovered to 85% of the healthy side, and 3 affected fingers had their total active range of motion recovered to 75% of the healthy side; the flap sensory recovery was as follows: the sense of 15 flaps with nerve anastomosis all recovered to grade S3 ⁺, and the two-point discrimination distance of skin in the flap area was 7.0-9.0 mm; the sense of 1 flap without nerve anastomosis recovered to grade S2 and the sense of 4 flaps recovered to grade S1. The satisfaction with curative effect of 20 patients was very satisfied in 16 cases and moderately satisfied in 4 cases, with the very satisfied rate of 80%; the repair result of 20 flaps was excellent in 16 cases, good in 2 cases, and fair in 2 cases, with excellent and good rate of 90%. Conclusions Due to the similar tissue structure of donor site and recipient site, foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers can achieve good appearance and function, with better functional and sensory recovery of the affected finger in the case of nerve anastomosis. Patients have high degree of satisfaction with the curative effects, which is worthy of promotion.
- Burns, electric /
- Finger injuries /
- Surgical flaps /
- Microsurgery /
- Wound repair
薛继东、梁琰：手术操作、数据收集、论文撰写；邢培朋、郭海娜、赵孝开、王丽敏：数据整理；狄海萍、夏成德：研究指导、论文修改、经费支持

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1 采用拇趾腓侧皮瓣修复例1患者左手示指掌侧Ⅳ度电烧伤创面。1A.术前左手示指掌侧创面基底可见黑色腐肉样组织；1B.清创后可见左手示指桡侧固有血管和神经、指深屈肌腱缺损；1C.设计右拇趾腓侧皮瓣，皮瓣蒂部设计成三角形；1D.皮瓣切取后，其神经、血管蒂长约4 cm；1E.皮瓣移植至创面，吻合血管及神经，边缘缝合后即刻；1F、1G、1H.分别为术后12个月末次随访时，皮瓣存活良好、外形不臃肿，左手握拳状、示指屈曲自如，皮瓣供区未见明显瘢痕

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2 采用足底内侧皮瓣修复例2患者右手拇指掌侧Ⅳ度电烧伤创面。2A.入院时右手拇指掌侧创面基底可见黑色腐肉样组织；2B.清创后可见拇指指间关节开放，部分骨质外露；2C.术中设计左足底内侧皮瓣；2D.切取得到携带血管、神经的皮瓣；2E.皮瓣移植至创面，吻合血管及神经后，边缘已缝合；2F.术后4个月，皮瓣存活良好、外形不臃肿；2G、2H.分别为术后14个月末次随访时，右手握拳状、拇指屈曲自如，皮瓣供区未见明显瘢痕

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