关键词：组织移植；手损伤；显微外科手术；临床方案
【摘要】 目的 探讨用双足供区5个组织瓣的组合移植,修复全手脱套伤伴5指缺损的优缺点。方法 1999年7月,为1例患者设计并应用了该新术式。 (1)患侧供足:设计并切取以足背动脉为蒂的携带甲瓣的足背皮瓣,修复手背、虎口及重建拇指。足背动静脉与桡动静脉吻合,大隐静脉与头静脉吻合。切取以第一、二趾足底总动脉为蒂的第二足趾游离移植再造示指。第二足趾的桡侧趾足底固有动脉通过血管桥接与足背皮瓣的足底深支作串联吻合;尺侧趾足底固有动脉与另一组足内侧皮瓣的足底深支作串联吻合;趾静脉与足背皮瓣远端及前臂背侧浅静脉吻合。(2)健侧供足:设计并切取以足背动脉为蒂的携带第二足趾的足内侧皮瓣，修复手掌、虎口及重建中指。足背动静脉与尺动静脉吻合,大隐静脉与前臂内侧浅静脉吻合。足背创面用中厚皮片植皮。 结果 5个移植组织瓣全部成活。术后随访2个多月,虎口大小基本同健侧,再造拇指对指、掌侧外展功能基本恢复。重建3指的痛觉开始恢复。 足部活动时无不适感。 结论 该术式是修复全手脱套伤伴5指缺损方法中最新最佳的一种方法。
Compositetransfer of five transplants for repair of total hand degloving injury combined with fivedigit loss
WANG Shufeng, ZHANG Gaomeng, LU Peifa, etal. Department Of Orthopedic Surgery, Center Hospital Of Binzhou Prefecture, Shandong251700
【Abstract】 Objective Tointroduce the procedure of composite transfer of five transplants from two feet for repairof total hand degloving injury combined with five digit loss, and discuss the advantagesand disadvantages. Methods In July1999, one case of total hand degloving injury combined with five digit loss was treatedwith the following procedure. (1) Ipsilateral foot: The dorsal flap of the foot along withthe big toe skin - nail flap based on the dorsalis pedis artery was harvested to cover thedorsum of the hand and the first web, and reconstruct the thumb. The dorsalis pedis arteryand its concomitant veins were anastomosed with the radial artery and its concomitantveins, whereas the greater saphenous vein was anastomosed to the cephalic vein. The secondtoe pedicled with the first and second plantar metatarsal artery was taken to reconstructthe index finger. The plantar artery at the tibial side was anastomosed with the deepplantar branch of the dorsal flap in a series fashion. The plantar artery at the fibularside was anastomosed with the deep plantar branch of the medial flap from the oppositefoot in a series fashion. The digital veins were drained to the superficial veins at thedorsum of the forearm via the veins of the dorsal flap in a pass - through fashion. (2)Contralateral foot: The medial flap along with the second toe based on the dorsalis pedisartery were harvested to cover the palm and the first web and reconstruct the middlefinger. The dorsalis pedis artery and its concomitant veins were anastomosed with theulnar artery and its concomitant veins, whereas the greater saphenous vein was anastomosedto the superficial vein of the forearm. The defect of the donor area was closed by splitthickness skin graft. Results Allthe five transplants survived. Follow - up at two months postoperatively revealed that thefirst web space was as wide as the opposite side. The abduction and opposition of thethumb was near normal. There was sign of sensory recovery in the three reconstructeddigits. The patient didn't complain discomfort of the donor feet.Conclusions This procedure of composite transplantation was a new and idealmethod for treatment of total hand degloving injury combined with five digit loss.
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