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足背双叶皮瓣游离移植修复拇指大面积皮肤缺损的临床效果

The effect of composite dorsalis pedis free skin flap to repair pollex of large area skin wounds
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摘要 目的分析足背双叶皮瓣游离移植修复拇指大面积皮肤缺损的临床效果。方法 12例拇指皮肤大面积损伤病人,设计用胫前动脉静脉或足背动静脉为蒂,第一跖背、跗外侧足背双叶皮瓣,一次性修复拇指大面积皮肤缺损。观察皮瓣成活情况,创面愈合情况。结果术后11例(91.67%)皮瓣一期成活,1例(8.33%)皮瓣出现血管危象坏死,经换药后二期植皮修复;创面11例(91.67%)一期愈合,其中1例(8.33%)术后第2天出现皮瓣下血肿,导致皮瓣坏死,经二期植皮后愈合;供区足背创面植皮部分坏死1例,经换药治疗后愈合。经4~14个月随访,皮瓣外形肤色恢复良好,两点分辨感觉平均恢复5~8 mm。手指屈伸活动功能满意。结论足背双叶皮瓣游离移植修复拇指大面积皮肤缺损,皮瓣成活率、创面愈合率较高;两个皮瓣共用一套血管,简化手术操作,提高手术成功率;还可以修复受伤拇指的伸缩及感觉功能,能够做到'功能性修复',值得在临床上大力推广。 Objective To analysis of the effect of composite dorsalis pedis free skin flap to repair pollex of large area skin wounds.Methods 12 patients with extensive skin lesions of the thumb and skin were selected.The anterior tibial artery or the dorsal arteries and veins were designed as the pedicle.Leaf flaps,which repair large areas of the thumb with a single defect.Observe the survival of the flap and the healing of the wound.Results 11 cases(91.67%)of the flap survived in the first stage,1 case(8.33%)showed vascular crisis necrosis,and the second stage of skin graft repair after dressing change;11 cases(91.67%)of the wound healed in the first stage.1 case(8.33%)showed subcutaneous flap hematoma on the second day after operation,which led to necrosis of the skin flap and healed after the second stage of skin grafting.1 case of necrosis of the skin graft in the donor site was healed after dressing change.After 4 to 14 months of followed-up,the skin color of the flap recovered well,and the two-point resolution felt an average of 5 to 8 mm.The function of finger flexion and extension is satisfactory.Conclusion The free flap of the dorsal dorsum flap can repair the large area of the skin defect of the thumb.The survival rate of the flap and the wound healing rate are high.The two flaps share a set of blood vessels,simplify the operation and improve the success rate of the operation.The flexion and sensory function of the thumb can achieve'functional repair',which is worthy of promotion in the clinic.
作者 菅志飞 孙维 杨华清 田彩霞 JIAN Zhifei;SUN Wei;YANG Huaqing(Department of Traumatology,Dongfeng General Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,China)
出处 《临床外科杂志》 2019年第4期342-345,共4页 Journal of Clinical Surgery
基金 十堰市科学技术局资助项目(14Y22).
关键词 足背双叶皮瓣 游离移植 皮肤缺损 功能性修复 composite dorsal foot skin flap free grafting skin defect functional repair
作者简介 通信作者:杨华清,Email:yanghuaqing69@163.com
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