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REPAIR OF MULTIPLE FINGERS DEGLOVING INJURY WITH ABDOMINAL“S”-TYPE SKIN FLAP

OBJECTIVE: To explore a new surgical management of multiple fingers degloving injury. METHODS: In 1994 to 1997, 47 cases with multiple fingers degloving injury were sutured by two reverse "s"-type skin flaps on abdominal flank. RESULTS: The skin flaps in 46 cases survived and the wounds obtained primary heal. CONCLUSION: The application of abdominal flank "s"-type skin flap is reliable and convenient in the treatment of multiple fingers degloving injury.

ILIO INGUINAL HYPOGASTRIC VASCULAR NETWORK SKIN FLAP WITH COMMON PEDICLE IN THE TREATMENT OF DEGLOVING INJURY OF MULTIPLE FINGERS

OBJECTIVE In order to solve the difficult problem of one-stage repair of degloving injury of multiple fingers, the common pedicled ilio-inguinal-hypogastric subdermal vascular network skin flap was designed and the multi-lobes skin flap was performed subsequently. METHODS From 1993 to 1996, there were 5 cases with degloving injuries of multiple fingers were treated by this flap. There were 2 males and 3 females and the age ranged from 7 to 19 years old. RESULTS After operation, the pedicles of the flap was detached between 12 to 16 days and all of the flaps survived completely. Patients were followed up for 6-18 months. After repair, the contour and skin colour of the digits were excellent, and the motion of the interphalangeal joints and skin sensation were good. CONCLUSION The conclusion was as follows: The newly designed skin flap was characterized by the advantages of duration of treatment being short, excellent contour and more rapid recovery of function. It could be used for one-stage repair of degloving injury of multiple fingers.

改良邻指皮瓣联合第二趾甲瓣修复手指中末节皮肤脱套伤

目的 总结采用改良邻指皮瓣联合第2 趾甲瓣修复手指中末节脱套伤的方法及临床疗效。方 法 2005 年 9 月－ 2009 年12 月，收治11 例11 指手指中末节皮肤脱套伤患者。男8 例，女3 例；年龄21 ～ 45 岁，平均28 岁。损伤原因：绞伤8 例，挤压伤3 例。损伤指别：示指5 例，中指5 例，环指1 例。皮肤撕脱平面：远指间关节 4 例，中节中部5 例，近指间关节2 例。创面范围6 cm × 3 cm ～ 7 cm × 4 cm。受伤至手术时间2 ～ 4 d，平均3 d。采用3.5 cm ×3.0 cm ～ 4.0 cm × 3.5 cm 的改良邻指皮瓣联合2.5 cm × 2.0 cm ～ 6.0 cm × 2.5 cm 的第2 趾甲瓣修复创面。改良的邻指皮瓣均带有指固有动脉背侧支，蒂宽1.0 ～ 1.5 cm。供区取中厚皮片植皮修复。 结果 术后皮瓣及植皮均顺利成活，供受区切口均Ⅰ期愈合。11 例均获随访，随访时间4 ～ 10 个月。趾甲生长良好，外形较满意。指腹感觉恢复，两点辨别觉为6 ～ 8 mm，平均6.5 mm。手指伸屈功能按手指总主动活动度（TAM）评分法评定，优8 指，良3 例。 结论 改良邻指皮瓣联合第2 趾甲瓣是修复手指中末节皮肤脱套伤的一种较好方法。

UDGEMENT OF SKIN VIABILITY IN DEGLOVING INJURIES BY SPLIT THICKNESS SKIN EXCISION

In extensive frictionavulsion injuries, part of the injuried skin was still viable, so that total excision of the avulsed skin should be avoided. After debridememt, sutured the avulsed skin flap in situ temporarily and took a split-thickness graft from it. If bleeding occurred from the splitted surface of the dermis which was meant that part of the skin was alive. Along the border between the bleeding and nonbleeding area, the nonbleeding area of skin was excised. This could preserve the viable skin to the maximal extent. From July 1991 to May 1992, the viability of the skin in 8 avulsion injuries was judged. The maximal avul sed area was 13% and the minimal was 6% of the total body surface. After the treatment, 90% of the avulsed skin was alive. The appearance was satisfactory.

双侧股前外侧皮瓣瓦合修复全足皮肤脱套伤

同指指动脉背侧皮支血管链皮瓣逆行修复手指指端脱套伤

目的探讨同指指动脉背侧皮支血管链皮瓣逆行修复手指指端脱套伤的疗效。方法2015 年 9 月—2017 年 2 月，收治 25 例（25 指）第 2～5 指指端脱套伤患者。男 16 例，女 9 例；年龄 20～63 岁，平均 38 岁。致伤原因：机器绞伤 12 例，挤压伤 8 例，重物砸伤 5 例。受伤至手术时间为 2.0～5.5 h，平均 4.0 h。指端创面范围为 2.0 cm×1.8 cm～4.0 cm×2.3 cm。采用大小为 2.2 cm×2.0 cm～4.4 cm×2.5 cm 的同指指动脉背侧皮支血管链皮瓣修复创面，皮瓣携带的指固有神经背侧支及指背神经与创面内双侧指固有神经残端吻合。供区游离植皮。结果术后 2 例皮瓣出现静脉回流障碍，对症处理后成活；其余皮瓣以及全部供区植皮均顺利成活。患者均获随访，随访时间 10～18 个月，平均 15 个月。皮瓣外形、颜色、质地良好，末次随访时皮瓣静态两点辨别觉为 5～9 mm，平均 6.9 mm。伤指功能参照中华医学会手外科学会上肢部分功能评定试用标准，获优 17 例、良 7 例、可 1 例。结论采用同指指动脉背侧皮支血管链皮瓣逆行修复指端脱套伤，操作简便、供区损伤小，疗效满意。

吻合静脉加负压引流治疗全手掌皮肤脱套伤

目的 总结吻合静脉加负压引流治疗全手掌皮肤脱套伤的治疗方法和临床效果。 方法 2005 年6 月－ 2007 年9 月，收治全手掌皮肤脱套伤7 例。男5 例，女2 例；年龄17 ～ 45 岁，平均30 岁。机器压伤5 例，滚轴绞伤2 例。手掌、手背自腕横纹逆行脱套至指蹼。受伤至手术时间为1 ～ 6 h，平均3 h。术中吻合皮下静脉、重建静脉回路，伤口内放置负压引流进行原位修复。 结果 6 例脱套皮肤全部成活；1 例脱套皮肤远端掌侧部分坏死，行游离植皮后成活。7 例均获随访，随访时间3 ～ 17 个月，平均12 个月。手部外形及色泽基本正常，出汗正常，手指屈、伸及感觉功能恢复良好。按中华医学会手外科学会上肢部分功能评定试用标准：获优3 例，良3 例，差1 例，优良率85.7%。 结论 吻合静脉加负压引流可以减轻皮肤水肿，提高脱套皮肤的成活率，是治疗全手掌皮肤脱套伤的一种较好方法。

MICROSURGICAL REPAIR OF SKIN-DEGLOVING INJURY OF WHOLE HAND OR FOOT

OBJECTIVE: To investigate the clinical effects of the microsurgical treatment for the skin-degloving injury of the whole hand or foot. METHODS: From March 1984 to October 2001, we treated 6 cases of skin-degloving injury of the whole hand and foot. In 2 cases of skin-degloving hands, one was treated with free great omentum transplantation plus skin graft, the other with pedical abdominal S-shaped skin flap as well as mid-thick skin graft. In 4 cases of skin-degloving injury of the foot, 2 cases was repaired with free latissimus dosi musculocutaneous flap, 1 case with distall-based lateral skin flap of the leg and 1 case with free tensor fasciae latae muscle flap. The flap size ranged from 7 cm x 9 cm to 22 cm x 15 cm. One case was operated on the emergency stage, the other 5 cases on the delayed stage. The delayed time ranged from 2 to 14 days with an average of 6.6 days. RESULTS: All the flaps survived. After 1-2 year follow-up, the appearance and function of the hand and the foot were good. CONCLUSION: Microsurgery technique in repairing skin-degloving injury of the whole hand and foot can achieve good results. The keys to success are thorough debridement of the recipient area, appropriate selection of the donor site, good vascular anastomosis and active postoperative rehabilitation.

双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤

目的总结双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤疗效。 方法2013年6月－2014年12月，采用双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤11例。男8例，女3例；年龄23～ 47岁，平均30岁。致伤原因：绞伤4例，压榨伤7例。损伤指别：示指4例，中指5例，环指2例。皮肤软组织脱套平面均在远指间关节以远。皮肤缺损范围3.0 cm×3.0 cm～5.0 cm×3.5 cm。受伤至手术时间4～12 h，平均7 h。皮瓣切取范围为1.5 cm×1.5 cm ～?2.5 cm×1.5 cm。供区游离植皮修复。 结果术后皮瓣及植皮均成活，创面Ⅰ期愈合。患者均获随访，随访时间6～10个月，平均7个月。皮瓣质地柔软、色泽满意，指端饱满、不臃肿。术后2周皮瓣两点辨别觉为5～10 mm，平均7 mm。术后6个月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2例，优良率100%。 结论采用双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤具有操作简便、手术创伤小等优点，术后手部外观及功能恢复满意。

双蒂腹部真皮下血管网皮管修复2 ～ 5 指双指脱套伤

目的 总结双蒂腹部真皮下血管网皮管修复2 ～ 5 指双指脱套伤的临床效果。 方法 2003 年2 月－ 2006 年8 月，采用双蒂腹部真皮下血管网皮管修复6 例双指脱套伤。男4 例，女2 例；年龄17 ～ 45 岁。示、中指2 例，中、环指3 例，环、小指1 例。撕脱平面均于近节指横纹以远，伴不同程度肌腱及关节囊损伤、骨外露。损伤至手术时间为40 min ～ 5 d。术中设计7 cm × 5 cm ～ 12 cm × 7 cm 双蒂腹部真皮下血管网皮管修复缺损。 结 果 1 例2 指术后2 周断蒂，术后2 d 皮管远端表皮坏死，经换药后愈合；余5 例10 指术后3 周断蒂，皮管均顺利成活，伤口Ⅰ期愈合。腹部供区Ⅰ期愈合。6 例术后均获随访，随访时间3 ～ 12 个月。皮瓣外形恢复较满意，手功能按ATM 标准评分：优2 例，良3 例，中1 例。 结论 双蒂腹部真皮下血管网皮管具有手术操作简便、术后患者对手功能及外形恢复满意的优点，是修复2 ～ 5指双指脱套伤的理想方法之一。