“V”形皮瓣推移成形术治疗手指末节离断伤(1)
【摘要】 目的 探讨手指末节离断缺损并骨外露的治疗方法。方法 采用指腹皮瓣推移成形术治疗手指末节离断缺损并骨外露84例。结果 手指末节离断缺损并骨外露84例,男50例,女34例。年龄14个月～46岁;其中钝器切割伤26例,机器碾压伤48例,门夹伤5例,狗咬伤5例。受伤时间0.5～13 h。指腹皮瓣推移后全部成活, 外观美观,皮肤感觉良好,皮瓣推移成形修复指端缺损及骨外露,取得良好效果,末节缺损后对手的功能基本无影响。结论 采用皮瓣推移成形术,能一步到位,术后患肢愈合良好,外观功能无差异,不会再缩短患肢,不需二期手术,也可以在门诊手术治疗,不须住院,手术创伤小,出血量少,术后恢复快,且方法简单易行,对技术及设备均没有严格的要求,是治疗手指末节离断伤的一种简单及有效的手术方法。
【关键词】 手指末节;离断伤 ;皮瓣推移成形术
Skin flap advanced plasty for the isolated distal segment finger
, http://www.100md.com
CHEN Shi-qian.Overseas Chinese Hospital of Puning,Guangdong 515300,China
【Abstract】 Objective To try find out the treatment method of the isolated distal segment finger.Methods 84 cases with the isolated distal segment finger were treated by skin flap advanced plasty. Results There were 50 cases in men and 34 cases in female. The age was from 14 month to 46 year old. 26 cases were injuried by blunt cutting,48 cases by inventory mangled injury,5case by door clip and 5 case by dog bitting.The injuried time was 0.5 to 13 hours. Advanced skin flap in all cases were alive. The appearance of all injuried fingers were good and the function was one of effective and simple methods for the isolated distal segment finger. Conclusion Adopt piece of the skill developing skin,can achieve a goal in one leap,skill future trouble limb coalescence is fine,the outward appearance function has no difference,be unable to shorten the trouble limb again,have no need of two phasese of operation,also not bad in outpatient service operation treat,do not have to be in hospital.The operation wound is small,bleeding amounts are few,the skill queenrecovers quickly,method is easy to do and simplely,does not have the strict request.Skin is that the minor details curing a finger is one kind simple and effective operation method away from cutting off a wound’s piece of the skill developing to take shape.
, 百拇医药
【Key words】 Distal segment finger;Isolated injury;Skin flap advanced plasty
DOI:10.3760/cma.j.issn 1673-8799.2010.11.38
作者单位:515300广东省普宁华侨医院外科
近年来,由于机械技术的广泛应用,手指外伤的发生率越来越多,约占全部外伤的四分之一[1],尤其末节缺损最为常见,如处理不当,给患者的生活和工作带来诸多不便,造成较大的影响。我们采用指腹皮瓣推移成形术治疗手指末节离断缺损并骨外露84例,取得了良好效果,现报告如下。
1 资料与方法
1.1 临床资料 在2002年12月至2010年6月共收治手指末节离断缺损并骨外露84例,其中有男50例,女34例,年龄最大46岁,最小14个月,平均26.5岁;右拇指末节离断伤36例,右中指末节离断伤25例,左拇指末节离断伤10例,左中指末节离断伤9例,左无名指末节离断伤10例,单手指80例,2个手指2例,3个手指2例。其中钝器切割伤26例,机器碾压伤48例,门夹伤5例,狗咬伤5例。从受伤到就诊时间最短半 ,最长13 h,平均8.2 h,离断末节无法找到77例,有找到且有带来诊7例,但时间已超过8 h且部分创面欠整齐。有10例残指伤口较整齐,74例伤口呈不规则性,均可见指骨骨折端外露,36例指甲缺如,其中65例收住院手术,19例在门诊手术。
, 百拇医药
1.2 手术方法 患肢外展置于手术桌上,除5例小孩在手术室静脉麻下手术外,其余79例患者均行手指根部阻滞麻醉,先用2%碘酒及75%酒精消毒后,用0.2%利多卡因局部麻醉,手指根部上止血带,再用肥皂水涮洗手指、手部至前臂,伤口用双氧水、0.9%氯化钠注射液冲洗消毒后,伤口再用甲硝唑液冲洗,去除失活组织,及拔除将近脱落指甲,在手指腹侧作“V”字型切口,保留深部筋膜,皮瓣向前推移。远侧缘与甲床或指背缝合在一起,覆盖全部伤面及骨折端,供皮区直接缝合。
2 结果
84例均行指腹“V”型皮瓣推移术,覆盖全部骨折端,术后12~14 d伤口拆线,伤口愈合后皮瓣成活,外观美观,皮肤感觉良好,皮瓣推移成形修复指端缺损及骨外露,取得良好效果,末节缺损后对手的功能基本无影响。
3 讨论
手指末节离断伤是手外伤中一种常见而又重要的损伤,治疗效果的好坏直接影响到手的功能。手指末节离断伤为常见多发病,手外伤约占全部外伤的四分之一,多见于机械切压伤、钝器或切割伤、门夹伤以及动物咬伤等,以往多作创面修整或缩短手指,来消灭创面伤口,容易裂开,出现延迟愈合,并易引起指骨感染,裂开伤口对伤手的外观和功能造成很大影响[1],患者必须二次手术,部分患者往往需要再次缩短患肢,给患者带来很大痛苦。手指末节离断伤的治疗不单纯是闭合创面,更重要的是功能恢复问题。它不仅要求恢复指腹外形,还要求重建的指腹具有敏锐的感觉和良好的耐磨性。
共2页, 百拇医药(陈诗强)
【关键词】 手指末节;离断伤 ;皮瓣推移成形术
Skin flap advanced plasty for the isolated distal segment finger
, http://www.100md.com
CHEN Shi-qian.Overseas Chinese Hospital of Puning,Guangdong 515300,China
【Abstract】 Objective To try find out the treatment method of the isolated distal segment finger.Methods 84 cases with the isolated distal segment finger were treated by skin flap advanced plasty. Results There were 50 cases in men and 34 cases in female. The age was from 14 month to 46 year old. 26 cases were injuried by blunt cutting,48 cases by inventory mangled injury,5case by door clip and 5 case by dog bitting.The injuried time was 0.5 to 13 hours. Advanced skin flap in all cases were alive. The appearance of all injuried fingers were good and the function was one of effective and simple methods for the isolated distal segment finger. Conclusion Adopt piece of the skill developing skin,can achieve a goal in one leap,skill future trouble limb coalescence is fine,the outward appearance function has no difference,be unable to shorten the trouble limb again,have no need of two phasese of operation,also not bad in outpatient service operation treat,do not have to be in hospital.The operation wound is small,bleeding amounts are few,the skill queenrecovers quickly,method is easy to do and simplely,does not have the strict request.Skin is that the minor details curing a finger is one kind simple and effective operation method away from cutting off a wound’s piece of the skill developing to take shape.
, 百拇医药
【Key words】 Distal segment finger;Isolated injury;Skin flap advanced plasty
DOI:10.3760/cma.j.issn 1673-8799.2010.11.38
作者单位:515300广东省普宁华侨医院外科
近年来,由于机械技术的广泛应用,手指外伤的发生率越来越多,约占全部外伤的四分之一[1],尤其末节缺损最为常见,如处理不当,给患者的生活和工作带来诸多不便,造成较大的影响。我们采用指腹皮瓣推移成形术治疗手指末节离断缺损并骨外露84例,取得了良好效果,现报告如下。
1 资料与方法
1.1 临床资料 在2002年12月至2010年6月共收治手指末节离断缺损并骨外露84例,其中有男50例,女34例,年龄最大46岁,最小14个月,平均26.5岁;右拇指末节离断伤36例,右中指末节离断伤25例,左拇指末节离断伤10例,左中指末节离断伤9例,左无名指末节离断伤10例,单手指80例,2个手指2例,3个手指2例。其中钝器切割伤26例,机器碾压伤48例,门夹伤5例,狗咬伤5例。从受伤到就诊时间最短半 ,最长13 h,平均8.2 h,离断末节无法找到77例,有找到且有带来诊7例,但时间已超过8 h且部分创面欠整齐。有10例残指伤口较整齐,74例伤口呈不规则性,均可见指骨骨折端外露,36例指甲缺如,其中65例收住院手术,19例在门诊手术。
, 百拇医药
1.2 手术方法 患肢外展置于手术桌上,除5例小孩在手术室静脉麻下手术外,其余79例患者均行手指根部阻滞麻醉,先用2%碘酒及75%酒精消毒后,用0.2%利多卡因局部麻醉,手指根部上止血带,再用肥皂水涮洗手指、手部至前臂,伤口用双氧水、0.9%氯化钠注射液冲洗消毒后,伤口再用甲硝唑液冲洗,去除失活组织,及拔除将近脱落指甲,在手指腹侧作“V”字型切口,保留深部筋膜,皮瓣向前推移。远侧缘与甲床或指背缝合在一起,覆盖全部伤面及骨折端,供皮区直接缝合。
2 结果
84例均行指腹“V”型皮瓣推移术,覆盖全部骨折端,术后12~14 d伤口拆线,伤口愈合后皮瓣成活,外观美观,皮肤感觉良好,皮瓣推移成形修复指端缺损及骨外露,取得良好效果,末节缺损后对手的功能基本无影响。
3 讨论
手指末节离断伤是手外伤中一种常见而又重要的损伤,治疗效果的好坏直接影响到手的功能。手指末节离断伤为常见多发病,手外伤约占全部外伤的四分之一,多见于机械切压伤、钝器或切割伤、门夹伤以及动物咬伤等,以往多作创面修整或缩短手指,来消灭创面伤口,容易裂开,出现延迟愈合,并易引起指骨感染,裂开伤口对伤手的外观和功能造成很大影响[1],患者必须二次手术,部分患者往往需要再次缩短患肢,给患者带来很大痛苦。手指末节离断伤的治疗不单纯是闭合创面,更重要的是功能恢复问题。它不仅要求恢复指腹外形,还要求重建的指腹具有敏锐的感觉和良好的耐磨性。
共2页, 百拇医药(陈诗强)