寿奎水 施海峰 214062无锡市手外科医院 中华手外科杂志 1999 0 0 1


    关键词：手损伤；外科皮瓣；康复；治疗结果 期刊 zhswkzz 0 论著 fur -->


    

【摘要】 目的 探讨一期修复全手脱套伤后的功能恢复及最佳修复术式。方法 对21例再造指的活动度、力量、感觉恢复程度和综合功能四项标准，分别计分后作综合评定。评定标准：优为13～16分，良为9～12分，可为5～8分，差为4分及4分以下。结果 术后功能恢复优良率：2块游离皮瓣瓦合包绕全手组为33.3%；甲瓣修复拇指、2块游离皮瓣覆盖2～5指及手掌、背创面组占71.4%；甲瓣修复拇指、1块游离皮瓣修复手掌背创面，加1个(或2个)足趾移植再造手指，这两组占90%。结论 应用甲瓣包绕再造拇指，2块游离皮瓣包绕2～5指及手掌背创面的方法最佳。对不能保留2～5指指骨者，在修复手掌背创面的同时，移植1或2个第2足趾再造示(中)指或示、中指者最佳。

Functional evaluation of composite tissue transfer for primary repair of deglovi ng injury of the hand SHOU Kuishui. SHI Haifeng. Wuxi Hand Surgery Hosp ital, Jiangsu 214062

    【Abstract】 Objective To evaluate the outcome of five types o f composite tissue transfer for treatme nt of degloving injury of the hand and seek the best operative procedure. Methods 21 cases of hand degloving injuries were primarily repaired w ith the following five procedures of composite tissue transfer:① wrap the hand with two free fla ps;② repair the thumb with wrap-around flap,and cover the rest of the hand w ith two free flaps;③ repair the thumb with wrap-around flap,cover the palm and dorsum of the hand with one free flap,and reconstruct one finger by toe tr ansp lantation so that the thumb and the finger could be opposed;④ repair the thumb with wrap-around flap, cover the palm and dorsum of the hand with one free flap, and reco nstruct two fingers by toe transplantation so that the thumb and the fingers c ould be opposed;⑤repair the thumb with wrap-around flap, cover the palm and d orsum of the hand with one free flap, and reconstruct the index and middle finge rs b y toe transplantation. Hand function was evaluated according to the sum of score s of motion range,strength, sensory recovery and comprehensive assessment of the reconstructed fingers and graded as excellent:13～16;good:9～12;fair:5～8;and poor: ≤4. Results The excellent and good rate of hand function was 33.3 % in method ① ,71.4 %in method ②, and 90 % in method ③and ④. Conclusions F or hand deglovin g injuries,the best approach is to repair the thumb with wrap-around flap,and c o ver the rest of the hand with two free flaps. If the second to fifth phalanx wer e injured, the best way is to reconstruct the index or/and middle finger by toe transplantation simultaneously when covering the palm and dorsum of the hand by flaps.

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