应用足部游离皮瓣移植修复手指皮肤软组织缺损的临床观察

来源:用户上传      作者:刘 柱　王路　毛秋影

　　[摘要]目的：探讨在修复手指皮肤软组织缺损时应用足部游离皮瓣移植的临床效果。方法：选取笔者医院2016年6月-2021年3月收治的手指皮肤软组织缺损患者52例作为研究对象，均采用足部游离皮瓣移植修复。所有患者术后随访6个月，对其进行疗效评估并记录其并发症情况。结果：足部游离皮瓣移植修复后，52例患者皮瓣均成活良好。随访6个月后进行手指功能评价，优良率为90.38%。随访期间，出现1例血管危象，3例感染，2例关节僵硬等并发症，总发生率为11.54%。结论：足部游离皮瓣移植修复手指皮肤软组织缺损疗效好，优良率高，g后并发症少，值得临床推广。
　　[关键词]手指;皮肤;软组织缺损;足部;皮瓣;修复
　　[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2022）01-0031-03
　　Clinical Observation of Repairing Finger Skin and Soft Tissue Defects with Free Foot Flap Graft
　　LIU Zhu，WANG Lu，MAO Qiuying
　　（Plastic and Cosmetic Surgery of General Hospital of Anhui Suzhou North Anhui Coal and Electricity Group Suzhou，Suzhou 234000，Anhui，China）
　　Abstract： Objective To investigate the clinical effect of free skin flap transplantation of feet in repairing skin and soft tissue defects of fingers. Methods 52 patients with finger skin and soft tissue defects admitted to our hospital from June 2016 to March 2021 were selected as the research objects， and they were all repaired with free foot flap transplantation. All patients were followed up for 6 months after operation to evaluate their efficacy and record their complications. Results After the free foot flap transplantation was repaired， the flaps of 52 patients survived well. The finger function was evaluated after 6 months of follow-up. Among them， 20 patients were excellent， 27 patients were good， 3 patients were fair， and 2 patients were poor， and the excellent and good rate was 90.38%. During the follow-up period， 1 patient was vascular crisis， 3 patients were infections， 2 patients were joint stiffness， and the total incidence of complications was 11.54%. Conclusion The free skin flap transplantation on the foot to repair finger skin and soft tissue defects has good curative effect， high excellent and good rate， and few postoperative complications， which is worthy of clinical promotion.
　　Key words： fingers; skin; soft tissue defects; feet; flaps; repair
　　手指皮肤软组织缺损是临床中常见的手外科损伤，以不规则创面为主，常伴有肌腱和指骨外露或坏死，不利于手指的功能恢复[1-2]。随着医疗技术的发展，患者对手指创伤的修复要求不断提高，在最大程度恢复原有手指功能的同时还需保证良好的外观恢复[3-4]。由于手指解剖结构的特殊性，直接缝合拉拢创面难度较高，常规植皮也无法满足创面闭合，目前临床上应用效果最好的治疗方式为皮瓣移植修复[5-6]。可用于修复手指皮肤软组织缺损的皮瓣主要有带蒂皮瓣和游离皮瓣，但带蒂皮瓣具有一定的局限性，无法用于伴有蒂部血管损伤的创面，且恢复效果不理想[7-8]。足部游离皮瓣移植是以足部为供区的修复方式，由于足部与手指皮肤具有同源性，其结构、厚薄相似性高，为手指的恢复创造了有利条件[9]。本研究旨在探讨应用足部游离皮瓣移植修复手指皮肤软组织缺损的临床效果，总结分享笔者医院治疗手指软组织缺损的临床经验，以期为临床治疗提供一定参考依据。具体报道如下。
　　1 资料和方法
　　1.1 一般资料：选取笔者医院2016年6月-2021年3月收治的52例手指皮肤软组织缺损患者作为研究对象。男性28例，女性24例;年龄3～70岁，平均年龄（35.26±10.94）岁;致伤原因：机器绞伤16例，重物砸伤12例，电锯伤8例，其他16例。本研究经笔者医院伦理委员会批准，患者及家属知情同意并签署知情同意书。
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