| 不同微型皮瓣修复手指软组织或合并骨缺损的临床疗效 |
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Received:July 08, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 杜伟斌 |
DU Wei-bin |
浙江中医药大学附属江南医院 萧山中医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 王利祥 |
WANG Li-xiang |
浙江中医药大学附属江南医院 萧山中医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
dwbbdm@163.com |
| 申丰 |
SHEN Feng |
浙江中医药大学附属江南医院 萧山中医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 曾林如 |
ZENG Lin-ru |
浙江中医药大学附属江南医院 萧山中医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 吴档 |
WU Dang |
浙江中医药大学附属江南医院 萧山中医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 吴国明 |
WU Guo-ming |
浙江中医药大学附属江南医院 萧山中医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 许良 |
XU Liang |
浙江中医药大学附属江南医院 萧山中医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 期刊信息：《中国骨伤》2019年32卷，第1期，第56-59页 |
| DOI：10.3969/j.issn.1003-0034.2019.01.012 |
| 基金项目:杭州市科技计划引导项目（编号：20171226Y93）；杭州市卫生科技计划项目（编号：2018B030）；杭州市萧山区重大科技攻关项目（编号：2017208） |
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目的：探讨3种不同类型微型皮瓣移植修复手指软组织或合并骨缺损的手术方法及临床疗效。
方法：选取2014年12月至2016年10月收治的33例手指软组织或合并骨缺损患者，男24例，女9例；年龄21~52（36.42±5.70）岁；软组织缺损面积：1.3 cm×1.8 cm~2.3 cm×4.2 cm。根据损伤程度、性质和患者意愿，其中15例（15指）行逆行掌背动脉穿支筋膜皮瓣，9例（10指）行游离尺动脉腕上皮支下行支皮瓣，9例（9指）行游离第2趾末节趾骨复合皮瓣。观察患者术后皮瓣成活率和并发症情况，并采用Dargan功能标准评定手指功能评价临床效果。
结果：所有皮瓣均存活，供区和受区未发生深部感染情况，其中1例供区出现植皮部分坏死，1例供区远端部分表皮坏死，经创面积极换药后愈合。33例患者获得随访，时间6~16（8.34±1.28）个月。修复手指两点分辨觉为8~12（8.84±0.43）mm，患指皮瓣外形、质地、感觉功能均得到良好恢复；供区未见明显并发症。手指关节Dargan功能评价：优18例，良14，中1例。
结论：3种微型皮瓣修复手指软组织或合并骨缺损均可获得良好疗效。逆行掌背动脉穿支筋膜皮瓣无须吻合血管，操作安全、简单，成活率高。游离尺动脉腕上皮支下行支皮瓣可同期切取其他多个穿支皮瓣分别修复缺损创面，瘢痕小且隐蔽。游离第2趾末节趾骨复合皮瓣能最大限度修复手指形态、功能，供区隐蔽。 |
| [关键词]:外科皮瓣 软组织损伤 指骨 |
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| Different mini skin flaps in repairing finger soft tissue with bone defect |
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Abstract:
Objective: To explore surgical methods and clinical effects of three different types of mini skin flap transplantation for repairing finger soft tissue with bone defect.
Methods: Thirty-three patients with finger soft tissue or bone defect were treated from December 2014 to October 2016,including 24 males and 9 females aged from 21 to 52 years old with an average of (36.42±5.70) years old,and soft tissue defect area ranged from 1.3 cm×1.8 cm to 2.3 cm×4.2 cm. According to damage degree,nature and patients' options,15 finger of 15 cases were adopted retrograde dorsal metacarpal artery perforators fascia flap,10 fingers of 9 cases were treated with free foot artery descending branch wrist skin flap,9 fingers of 9 cases were treated with free the second toe details phalanges compound flap. Survival rate,postoperative complications and finger function assessed by Dargan functional criteria at the latest follow up were observed.
Results: All flaps were survived,both of donor site and recipient site were without deep infected. The donor site of one patient occurred necrotic,and the distal donor site of one patient occurred surface necrotic,then healed by active dressing change. All patients were followed up from 6 to 16 months with an average of(8.34±1.28) months. Two points of finger recognition were restored between 8 and 12 mm with an average of (8.84±0.43) mm,and the appearance,texture and sensory functions of skin flap were restored. No obvious complications were observed on the donor site. According to Dargan function evaluation of finger joints,18 patients got excellent results,14 moderate and 1 good.
Conclusion: Three kinds of mini skin flap could receive good results in repairing soft tissue of finger or bone defect. Reverse dorsal metacarpal artery perforator fascia flap is not necessary with anastomosing blood vessels and has advantages of safe,simple and high survival rate. Descending branch of superior cutaneous branch of free ulnar artery could cut multiple other perforator flaps simultaneously,and the scar is small and hidden. Dissociated the second toe combined metatarsal phalangeal flap could repair shape and function of finger to the maximum extent and donor site is hidden. |
| KEYWORDS:Surgical flaps Soft tissue injuries Finger phalanges |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 杜伟斌,王利祥,申丰,曾林如,吴档,吴国明,许良.不同微型皮瓣修复手指软组织或合并骨缺损的临床疗效[J].中国骨伤,2019,32(1):56~59 |
| 英文格式: | DU Wei-bin,WANG Li-xiang,SHEN Feng,ZENG Lin-ru,WU Dang,WU Guo-ming,XU Liang.Different mini skin flaps in repairing finger soft tissue with bone defect[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(1):56~59 |
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