踇趾腓侧\第二趾胫侧单叶或分叶皮瓣治疗手指软组织缺损(1)
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【摘要】目的:探讨踇趾腓侧、第二趾胫侧单叶或分叶皮瓣修复手指软组织缺损的方法和疗效。方法:自2009年起，应用踇趾腓侧单叶皮瓣移植9例，第二趾胫侧单叶皮瓣移植15例，踇趾腓侧及第二趾胫侧分叶皮瓣修复手指软组织缺损8例。皮瓣切取面积为1.5cm×1.8cm～2.5cm×6.0 cm。结果:32例皮瓣均成活，其中1例皮瓣术中因动、静脉错接发生血管危象，经重新调整吻合后，皮瓣存活；1例皮瓣术后发生伤口感染，经积极换药、全身应用抗生素等综合治疗后愈合。随访3～12个月，足部供区创面一期愈合，无磨损、溃疡，外形及功能均恢复良好。受区皮瓣不臃肿、指体饱满、外形逼真、两点辨别觉为6mm～10mm，各关节主、被动屈伸功能基本正常。结论:踇趾腓侧、第二趾胫侧单叶或分叶皮瓣质地薄、色泽好，有感觉，修复后外形好，是一种理想的手术方法。
【关键词】足部皮瓣；分叶皮瓣；显微外科
【中图分类号】R658.2 【文献标识码】A 【文章编号】1008-6455(2011)12-0034-02
Mu toe fibular, tibial second toe single leaf or leaf flap of finger soft tissue defect treatment
Shen Meihua Zheng Wei Jin Fan et al.
【Abstract】Objective:To explore Mu toe fibular, tibial second toe single leaf or leaf flap repair of finger soft tissue defect of the method and effect. Methods:Since 2009, the application of single leaf Mu toe fibular flap in 9 cases, a single leaf tibial second toe flap in 15 cases, Mu toe and second toe fibular tibial side of the leaf flap of finger soft tissue defect of 8 Cases. Flap area of 1.5cm × 1.8cm ～ 2.5cm × 6.0 cm. Results:32 patients with flaps all survived, including 1 flap surgery because of arterial and venous vascular crisis the wrong place then, the restructuring agreement, the flap survival; 1 flap postoperative wound infection, the active medication, Comprehensive treatment of systemic antibiotics after healing. 3 to 12 months follow-up, foot wound healing in donor site, no wear, ulcers, form and function are recovered well. Not bloated by the flap, means the body full, realistic appearance, two points discrimination of the 6mm～10mm, the joint active and passive flexion and extension function was normal. Conclusion:Mu toe fibular,tibial second toe leaf single leaf or a thin flap texture, good color, a feeling, a good appearance after repair, is an ideal surgical method.
【Key words】Foot flap; Leaf flap; Microsurgical treatment
单指或多指软组织缺损临床上较常见，修复方法也很多。传统的远位皮瓣或带蒂皮瓣转移均不同程度存在修复后外形臃肿、感觉障碍等缺憾。随着足部皮瓣的大力开发，手外伤的修复从外形和功能方面得到质的飞跃，但由于常破坏足部主干血管，供足出现较多如足部供血不足、易冻伤、伤口难愈、瘢痕等并发症。因此要求术者在切取足部组织时，尽量减少对足部功能的损害。近年来临床上带趾底固有动脉的踇趾或第二趾皮瓣〖1-3〗,屡见报道，而带趾背动脉的踇趾腓侧、第二趾胫侧皮瓣皮瓣国内鲜有报道。我院从2009年8月至2011年4月，采用该皮瓣治疗手指软组织缺损，获得了满意的临床效果，现报道如下。
1 资料与方法
1.1 临床资料:本组32例，男21例，女11例；年龄18～56岁，平均24.2岁。致伤原因：机器绞伤7例，铡草机割伤14例，重物砸伤6例，电锯割伤5例。损伤指别：拇指6例，示指13例，中指8例，环指3 例，小指2例 ......
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