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游离前臂骨间背侧皮瓣修复手指皮肤软组织缺损

【摘 要】 目的 总结游离前臂骨间背侧皮瓣修复手指皮肤软组织缺损的疗效。 方法 2008 年7 月－ 2010 年5 月，收治12 例12 指手指皮肤软组织缺损患者。男9 例，女3 例；年龄17 ～ 35 岁，平均24.5 岁。机器挤压伤3 例，电刨伤5 例，电锯伤4 例。示指7 例，中指4 例，环指1 例。创面缺损范围为3 cm × 2 cm ～ 4 cm × 2 cm。受伤至手术时间 3 ～ 8 h，平均 4 h。采用大小为3.5 cm × 2.5 cm ～ 4.5 cm × 2.5 cm 的游离前臂骨间背侧皮瓣移植修复创面，将皮瓣携带的骨间背侧动、静脉与受区指固有动脉或指总动脉、指背静脉或掌背远端浅静脉吻合。供区直接拉拢缝合。 结果 术后7 d，1 例皮瓣近端坏死，经换药后愈合；其余皮瓣均顺利成活，创面及供区切口均Ⅰ期愈合。患者均获随访，随访时间6 ～ 12 个月,平均9 个月。皮瓣质地优良，局部无臃肿，耐磨无溃疡。术后6 个月皮瓣两点辨别觉为8 ～ 10 mm，平均 9.3 mm。术后6个月手指功能按照中华医学会手外科学会上肢功能评定试用标准评定，获优 4 例，良 6 例，可 2 例。 结论 应用游离前臂骨间背侧动脉皮瓣移植修复手指皮肤软组织缺损可获得较好临床效果。

TISSUE TRANSPLANTATION WITH BONE TRANSMISSION FOR TREATING LARGE DEFECTS OF TIBIAL BONE AND SOFT TISSUE

Objective To investigate the effectiveness of tissue transplantation combined with bone transmission in treatment of large defects of tibial bone and soft tissue. Methods Between February 2006 and February 2011, 15 cases of traumatic tibia bone and soft tissue defects were treated. There were 12 males and 3 females, aged from 16 to 54 years (mean, 32 years). After internal and external fixations of fracture, 11 patients with open fracture (Gustilo type III) had skin necrosis, bone exposure, and infection; after open reduction and internal fixation, 2 patients with closed fracture had skin necrosis and infection; and after limb replantation, 2 patients had skin necrosis and bone exposure. The area of soft tissue defect ranged from 5 cm × 5 cm to 22 cm × 17 cm. Eight cases had limb shortening with an average of 3.5 cm (range, 2-5 cm) and angular deformity. The lenghth of bone defect ranged from 4 to 18 cm (mean, 8 cm). The flap transplantation and skin graft were used in 9 and 6 cases, respectively; bone transmission and limb lengthening orthomorphia were performed in all cases at 3 months after wound healing; of them, 2 cases received double osteotomy bone transmission, and 14 cases received autologous bone graft and reset after apposition of fracture ends. Results All flaps and skin grafts survived; the wound healed at 3.5 months on average (range, 3 weeks-18 months). The length of bone lengthening was 6-22 cm (mean, 8 cm). The time of bone healing and removal of external fixation was 9.5-39.0 months (mean, 15 months). The healing index was 40-65 days/cm (mean, 55 days/cm). All patients were followed up 1-5 years (mean, 4 years). The wounds of all the cases healed well without infection or ulceration. The functions of weight-bearing and walking were recovered; 6 cases had normal gait and 9 cases had claudication. The knee range of motion was 0° in extention, 120-160° in flexion (mean, 150°). According to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system for ankle function, the results were excellent in 7 cases, good in 4 cases, and fair in 4 cases, with an excellent and good rate of 73.3%. Conclusion Tissue transplantation combined with bone transmission is an effective method to treat large defects of soft tissue and tibial bone, which can increase strength of bone connection and reduce damage to the donor site.

双叶穿支皮瓣修复指背软组织缺损

目的总结指背双叶穿支皮瓣修复指背软组织缺损的临床疗效。 方法2015年3月-2016年3月，采用指背双叶穿支皮瓣修复指背软组织缺损13例。男6例，女7例；年龄19～66岁，平均31.7岁。致伤原因：机器冲压伤9例，重物压伤4例。受伤至入院时间40 min～36 h，平均7.4 h。指别：示指3指，中指5指，环指5指。缺损范围1.0 cm×1.0 cm～2.5 cm×2.0 cm。第1皮瓣覆盖缺损创面，第2皮瓣覆盖第1皮瓣供区，第2皮瓣供区直接缝合。 结果术后创面均Ⅰ期愈合。皮瓣均顺利成活，无血管危象发生。12例患者获随访，随访时间3～9个月，平均5.5个月。各皮瓣色泽红润、质地良好；第l皮瓣供区无凹陷、破溃，第2皮瓣供区线性瘢痕愈合，整体外观良好。末次随访时按手指主动活动度（TAM）法评定手功能：优9指、良3指。 结论采用指背双叶穿支皮瓣修复指背创面缺损，手术操作简便，疗效较好。

封闭式负压引流技术联合腓肠神经营养血管逆行岛状皮瓣修复下肢皮肤软组织大面积缺损

目的 总结封闭式负压引流技术（vacuum sealing drainage，VSD）联合腓肠神经营养血管逆行岛状皮瓣修复下肢皮肤软组织大面积缺损的临床疗效。 方法 2008 年1 月－ 7 月，收治25 例下肢皮肤软组织大面积缺损患者。男13 例，女12 例；年龄15 ～ 54 岁，平均34.4 岁。机器绞伤15 例，交通伤9 例，爆炸伤1 例。损伤部位：小腿中下段8 例，踝部4 例，足背部5 例，足跟部及跟腱部8 例。创面范围为9 cm × 4 cm ～ 12 cm × 9 cm。受伤至手术时间为1 ～ 12 h，平均6.2 h。先行VSD 治疗待创面肉芽组织新鲜、感染控制后，采用大小为10 cm × 7 cm ～ 13 cm × 11 cm 的腓肠神经营养血管逆行岛状皮瓣修复创面。供区直接缝合或游离植皮修复。 结果 皮瓣修复术后2 例出现皮瓣切口远端皮缘坏死，1 例静脉危象，经对症处理后成活；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区切口均Ⅰ期愈合，游离植皮成活。25 例均获随访，随访时间11 ～ 14 个月，平均13 个月。皮瓣与周围皮肤色泽相似，无臃肿，质地佳；皮瓣受力处无破溃。 结论 VSD 治疗能降低创面感染几率，为皮瓣修复提供良好组织床。腓肠神经营养血管逆行岛状皮瓣是修复下肢及远端足跟部皮肤软组织缺损的有效方法之一。

多块掌背动脉岛状皮瓣修复多指皮肤软组织缺损

目的 总结多块掌背动脉岛状皮瓣修复多指皮肤软组织缺损的疗效。 方法2009年7月－2011年8月，采用多块掌背动脉岛状皮瓣修复多指皮肤软组织缺损16例。男11例，女5例；年龄17～69岁，平均38岁。掌侧缺损4例，背侧缺损12例。软组织缺损范围1.0 cm × 0.5 cm～5.5 cm × 2.5 cm。伤后至入院时间为30 min～8 h，平均3 h。皮瓣切取范围1.2 cm × 1.0 cm～6.5 cm × 3.0 cm。供区拉拢缝合或植皮修复。 结果术后1例皮瓣远端坏死，1例皮瓣轻度感染，均经换药后成活；其余皮瓣及供区植皮均成活，切口均Ⅰ期愈合。术后16例患者均获随访，随访时间6～24个月，平均12个月。皮瓣外形、质地良好，末次随访时皮瓣两点辨别觉为7～11 mm；手指功能根据中华医学会手外科学会上肢部分功能评定试用标准：获优9例，良6例，可1例，优良率为93.8%。 结论利用掌背动脉、掌心动脉及掌侧指总动脉交通支相吻合的解剖特点，选择其各自走行上的掌背皮瓣修复多指皮肤软组织缺损，具有手术操作简便、安全、可靠等优点。

APPLICATION OF PEDICLED LATISSIMUS DORSI KISS FLAP TO REPAIR CHEST WALL SKIN DEFECTS AFTER TUMOR RESECTION

ObjectiveTo investigate the clinical value of pedicled latissimus dorsi Kiss flap in repairing chest wall large skin defect after tumor operation. MethodsA retrospective analysis was made on the clinical data from 15 cases of chest wall tumors treated between December 2010 and December 2015. There were 2 males and 13 females with an average age of 51.8 years (range, 43-60 years); there were 11 cases of locally advanced breast cancer, 3 cases of fibrosarcoma in chest wall, and 1 case of chest wall radiation ulcer with a median disease duration of 24.1 months (range, 6 months to 8 years). The area of skin defects was 17 cm×12 cm to 20 cm×18 cm after primary tumor resection; the pedicled latissimus dorsi Kiss flap was designed to repair wounds. The flap was a two-lobed flap at a certain angle on the surface of latissimus dorsi based on the thoracodorsal artery, with a size of 17 cm×6 cm to 20 cm×9 cm for each lobe. The donor site was sutured directly. ResultsFourteen flaps survived with primary healing of wound; delayed healing was observed in 1 flap because of distal necrosis; and healing by first intention was obtained at the donor sites. The follow-up time was from 6 months to 3 years (mean, 21.6 months). The flap had good appearance with no bloated pedicle. The shoulder joint activities were normal. No local recurrence occurred, but distant metastasis in 2 cases. No obvious scar was found at donor sites. ConclusionThe application of pedicled latissimus dorsi Kiss flap to repair chest wall skin defects after tumor resection has important clinical value, because of the advatages of simple operation, minor donor site damage and rapid postoperative recovery, especially for late stage cancer patients.

足踝部皮肤软组织缺损的修复

【摘 要】 目的 总结足踝部皮肤软组织缺损修复方法及疗效。 方法 2005 年8 月－ 2008 年8 月，收治46 例足踝部皮肤软组织缺损患者。男40 例，女6 例；年龄12 ～ 68 岁，平均35 岁。交通事故伤31 例，机器碾压伤6 例，医源性损伤2 例，电击伤1 例，糖尿病足溃疡6 例。缺损范围4 cm × 2 cm ～ 27 cm × 16 cm。病程4 h ～ 2 年。采用股前外侧游离皮瓣12 例，腓肠神经营养血管皮瓣25 例，胫后动脉逆行皮瓣1 例，隐神经皮瓣2 例，腓动脉终末穿支皮瓣2 例，交腿皮瓣1 例，足底内侧皮瓣2 例，跖背皮瓣1 例，皮瓣切取范围4 cm × 3 cm ～ 28 cm × 18 cm；供区直接缝合或中厚皮片游离移植修复。 结果 术后46 例患者均获随访，随访时间6 个月～ 3 年，平均11 个月。术后10 d 2 例腓肠神经营养血管皮瓣发生远端部分坏死；其余皮瓣均成活，创面Ⅰ期愈合。供区植皮均成活，无明显挛缩；切口Ⅰ期愈合。术后6 个月，1 例采用腓肠神经营养血管皮瓣修复的足底创面发生小面积溃疡，经对症处理后愈合；其余患者皮瓣质地、色泽正常。患者可负重行走，步态正常。 结论 合理采用局部带蒂皮瓣或游离皮瓣修复足踝部皮肤缺损，可明显缩短病程，达到保肢保足目 的。

REPAIR OF FOREFOOT SKIN AND SOFT TISSUE DEFECT WITH REVERSE LATERAL TARSAL ARTERY FLAP

Objective To investigate the operative procedure and the cl inical results of reverse lateral tarsal artery flap in treating forefoot skin and soft tissue defect. Methods From August 2007 to April 2009, 11 patients with forefoot skin and soft tissue defect were treated with reverse lateral tarsal artery flaps, including 7 males and 4 females aged from 16 to 60 years(36 years on average). Of 11 cases, defects were caused by crash in 5 cases, by grind contusion in 3 cases and the course disease was 4-12 hours; by tumor extended resection in 3 cases and the disease course was 3-12 months. There were 5 wounds on the dorsum of first metatarsophalangeal joint, 2 on the dorsum of the first toes, and 4 on the dorsum of distal part of metatarsal bones. The area of defect ranged from 4 cm × 2 cm to 6 cm × 5 cm. There were 6 cases of tendon exposure, 4 cases of tendon defect with bone exposure, and 1 case of tendon defect with open dislocation of metatarsophalangeal joint. The flap was designed with dorsal artery of foot as its pedicle. The plantar perforating branch was designed as its rotating point. And the flaps were transferred retrogradely to repair the forefoot wounds. The flap area ranged from 4.5 cm × 2.5 cm to 6.5 cm × 4.5 cm. The lateral dorsal nerve of foot was anastomosed with the nerve in wound area in 7 cases. Donor site was covered by full thickness skin graft. Results Partial necrosis occurred and was cured by dressing change, followed by skin graft in 2 cases. The flaps survived and primary heal ing was achieved in the other 9 cases. All the skin grafts of donor site survived and primary heal ing wasachieved after operation. All the patients were followed up for 6 months to 2 years, averaged 13 months. The texture and color of the flap were similar to skin at the recipient site. All patients returned to normal in walking and running and no ulceration occurred. The two point discrimination was 5-12 mm 6 months after operation in 7 patients who received nerve anastomosis, while only protective sensation recovered partly in the other 4 patients whose cutaneous nerve were not anastomosed. Conclusion Reverse lateral tarsal artery flap has the perfect shape and its blood vessel is constant. The blood pedicle is thick and long enough when transferred retrogradely. The flap is a good choice in the treatment of forefoot skin and soft tissue defect.

前臂桡侧逆行岛状皮瓣修复虎口皮肤及软组织缺损一例

皮肤伸展术在皮肤软组织缺损中的临床应用