足底内侧游离皮瓣整复手掌电烧伤创面及瘢痕挛缩的疗效

韩夫; 杨薛康; 何亭; 王路旭; 张楠; 韩军涛

doi:10.3760/cma.j.cn501225-20230601-00197

足底内侧游离皮瓣整复手掌电烧伤创面及瘢痕挛缩的疗效

doi: 10.3760/cma.j.cn501225-20230601-00197

空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032

详细信息

通讯作者:
韩军涛，Email：hanjt@fmmu.edu.cn

计量
- 文章访问数: 1209
- HTML全文浏览量: 43
- PDF下载量: 22
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-01

Curative effects of medial plantar free flap in reconstructing electric burn wound and scar contracture in the palm

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

More Information

Corresponding author: Han Juntao, Email: hanjt@fmmu.edu.cn

摘要

摘要: 目的探讨足底内侧游离皮瓣整复手掌电烧伤创面及瘢痕挛缩的疗效。方法采用回顾性观察性研究方法。2020年1月—2023年1月，空军军医大学第一附属医院收治6例符合入选标准的手掌电烧伤创面或瘢痕挛缩患者，其中男5例、女1例，年龄35~55岁。手掌电烧伤创面清创后及瘢痕切除后创面面积为5.0 cm×3.0 cm~8.0 cm×7.0 cm。均采用吻合皮神经的足底内侧游离皮瓣整复创面，皮瓣面积为5.5 cm×3.5 cm~8.5 cm×7.5 cm。移植腹部全厚皮修复皮瓣供区创面。术后观察皮瓣和皮片存活情况，随访观察皮瓣外形、质地及皮瓣供区情况，评估患手握持功能恢复情况。于末次随访时，测量皮瓣两点辨别觉距离并按照中华医学会手外科学会上肢部分功能评定试用标准评定皮瓣感觉恢复情况，采用皮瓣术后功能评价量表评价皮瓣功能恢复情况。结果术后5个皮瓣存活良好；1个皮瓣远端部分坏死，清创后移植大腿外侧中厚皮修复。皮瓣供区皮片均存活良好。随访3~24个月，皮瓣不臃肿，质地、色泽好，与周围组织匹配度高；皮瓣供区无明显瘢痕挛缩发生；患手握持功能良好。末次随访时，皮瓣两点辨别觉距离为6~8 mm，皮瓣感觉恢复：5个皮瓣恢复到S3 ⁺级、1个皮瓣恢复到S3级，皮瓣功能评定：优5个、良1个，患者基本恢复正常的生活和工作。结论吻合皮神经的足底内侧游离皮瓣整复手掌电烧伤创面及瘢痕挛缩具有术后外观匹配度高、感觉恢复良好及患手握持功能良好等诸多优点，是整复手掌电烧伤创面和瘢痕挛缩的理想选择。
- 烧伤，电 /
- 手损伤 /
- 瘢痕 /
- 外科皮瓣 /
- 显微外科手术 /
- 创面修复
Abstract: Objective To explore the curative effects of medial plantar free flap in reconstructing electric burn wound and scar contracture in the palm. Methods A retrospective observational study was conducted. From January 2020 to January 2023, 6 patients with electric burn wounds or scar contracture in the palm who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 5 males and 1 female, aged 35 to 55 years. The wound area was 5.0 cm×3.0 cm-8.0 cm×7.0 cm after the debridement of electric burn wounds or resection of scar in the palm. The medial plantar free flap anastomosed with cutaneous nerve was used for wound reconstruction, with flap area of 5.5 cm×3.5 cm-8.5 cm×7.5 cm. The wound in the donor site was repaired with transplantation of abdominal full-thickness skin graft. After surgery, the survival of flaps and skin grafts were observed, the shape and texture of flap and the recovery of donor site of flap were observed, and the holding function of the affected hand was assessed. At the last follow-up, the two-point discrimination distance of flap was measured, the sensory recovery of flap was 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, and the function recovery of flap was evaluated by post-surgery flap function evaluation scale. Results After surgery, 5 flaps survived well, while the distal part of 1 flap was partially necrotic, which was repaired by medium-thickness skin graft from lateral thigh after debridement. All the skin grafts at the donor sites survived well. During follow-up of 3 to 24 months, the flap was not bloated, the texture and color were good, the match with the surrounding tissue was high, with no obvious scar contracture occurred at the donor site. The affected hand had good holding function. At the last follow-up, the two-point discrimination distance of flap was 6-8 mm, the flap sensation recovery was as follows: 5 flaps recovered to grade S3 ⁺, 1 flap recovered to grade S3, and the functional evaluation of flaps was excellent in 5 cases and good in 1 case. The patients basically returned to normal life and work. Conclusions The medial plantar free flap with cutaneous nerve anastomosis has many advantages, such as high matching degree of appearance, good sensory recovery, and holding function of the affected hand. It is an ideal choice for the reconstruction of the electric burn wound and scar contracture in the palm.
- Burns, electric /
- Hand injuries /
- Cicatrix /
- Surgical flaps /
- Microsurgery /
- Wound repair
韩夫：实施手术、采集资料、分析数据、撰写论文；杨薛康、何亭、王路旭、张楠：实施手术、采集资料；韩军涛：酝酿和设计研究、实施手术、修改论文

所有作者均声明不存在利益冲突

HTML全文

参考文献(18)

[1]	黎鳌. 黎鳌烧伤学[M]. 上海:上海科学技术出版社, 2001.
[2]	TroisiL, BernerJE, WestEV, et al. Medial plantar flap for hand reconstruction: a systematic literature review and its application for post-sarcoma excision[J]. Ann Plast Surg, 2019,82(3):337-343.DOI: 10.1097/SAP.0000000000001568.
[3]	LeeK, RohS, LeeD, et al. Skin coverage considerations in a mutilating hand injury[J]. Hand Clin, 2016,32(4):491-503.DOI: 10.1016/j.hcl.2016.07.002.
[4]	GuillierD, CherubinoM, OrangesCM, et al. Systematic reappraisal of the reverse-flow medial plantar flap: from vascular anatomical concepts to surgical applications[J]. J Plast Reconstr Aesthet Surg, 2020,73(3):421-433.DOI: 10.1016/j.bjps.2019.10.019.
[5]	LiJY, LuoXC, ZouYG. Reconstruction of the palmar defect of the hand with a sensory medial plantar artery flap[J]. Front Surg, 2022,9:874629.DOI: 10.3389/fsurg.2022.874629.
[6]	侯春林,顾玉东. 皮瓣外科学[M]. 3版.上海:上海科学技术出版社, 2019.
[7]	PadovanoWM, HillEJR, FelderJM. Reconstruction of severe palm injury with sensate medial plantar artery flap and nerve grafting[J]. Plast Reconstr Surg Glob Open, 2020,8(7):e2944.DOI: 10.1097/GOX.0000000000002944.
[8]	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准[J]. 中华手外科杂志, 2000,16(3):130-135. DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003.
[9]	SmolleC, Cambiaso-DanielJ, ForbesAA, et al. Recent trends in burn epidemiology worldwide: a systematic review[J]. Burns, 2017,43(2):249-257.DOI: 10.1016/j.burns.2016.08.013.
[10]	薛继东,狄海萍,梁琰,等. 足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面的疗效[J].中华烧伤与创面修复杂志,2023,39(8):724-730 DOI: 10.3760/cma.j.cn501225-20230323-00094.
[11]	常致德. 电烧伤的治疗与研究[M]. 济南:山东科学技术出版社, 2000.
[12]	SenSK, Fitzgerald O'ConnorE, TareM. The free instep flap for palmar and digital resurfacing[J]. J Plast Reconstr Aesthet Surg, 2015,68(9):1191-1198.DOI: 10.1016/j.bjps.2015.05.012.
[13]	StarnoniM, BenantiE, AcciaroAL, et al. Upper limb traumatic injuries: a concise overview of reconstructive options[J]. Ann Med Surg (Lond), 2021,66:102418.DOI: 10.1016/j.amsu.2021.102418.
[14]	AppukuttanA, LohCYY, PuenteMM, et al. Reverse superficial palmar branch of radial artery pedicled flap for palmar and digital reconstruction: a systematic review of literature with a retrospective case review[J]. JPRAS Open, 2021,29:144-156.DOI: 10.1016/j.jpra.2021.05.008.
[15]	ZhouZF,JuJB,XingPP,et al.Efficacy and safety of free medial plantar flap in repair of the high-voltage electrical burns in hands[J].Eur J Trauma Emerg Surg,2022,48(2):1381-1387.DOI: 10.1007/s00068-021-01700-5.
[16]	Rodriguez-VegasM.Medialis pedis flap in the reconstruction of palmar skin defects of the digits: clarifying the anatomy of the medial plantar artery[J].Ann Plast Surg,2014,72(5):542-552.DOI: 10.1097/SAP.0b013e318268a901.
[17]	PagetJT,IzadiD,Haj-BasheerM,et al.Donor site morbidity of the medial plantar artery flap studied with gait and pressure analysis[J].Foot Ankle Surg,2015,21(1):60-66.DOI: 10.1016/j.fas.2014.09.009.
[18]	BlantonC, KercadoM, NordquistT, et al. Medial plantar artery common origin to determine incision placement for the fasciocutaneous flap: a cadaveric study[J]. J Foot Ankle Surg, 2020,59(3):462-464.DOI: 10.1053/j.jfas.2019.08.030.

下载: 全尺寸图片幻灯片

1 左侧足底内侧游离皮瓣修复例1患者左手掌电烧伤创面。1A.术前左手掌电烧伤创面可见皮革样坏死组织；1B.术中根据清创后创面大小设计皮瓣切取范围；1C.术后6个月，皮瓣外形良好；1D.术后6个月，皮瓣供区未见明显瘢痕挛缩形成

下载: 全尺寸图片幻灯片

2 左侧足底内侧游离皮瓣整复例2患者左手掌电烧伤后瘢痕挛缩。2A.术前左手掌电烧伤后瘢痕挛缩；2B.术中左手掌瘢痕切除松解后伴血管肌腱外露；2C.皮瓣整复瘢痕切除松解后创面术后即刻；2D.术后10个月，皮瓣外形良好

下载: 全尺寸图片幻灯片