拇指皮肤软组织缺损皮瓣修复方法的选择及临床体会(1)
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【摘要】目的：研究拇指外伤皮肤软组织缺损时皮瓣的修复方法及手术方法的效果。方法：选取2009年3月-2011年11月于本院治疗的50例拇指皮肤软组织缺损患者，将其分为三组，分别为游离皮瓣修复组、局部皮瓣修复组、带蒂皮瓣修复组，并对比治疗效果。结果：12例游离皮瓣修复患者中有7例患者达到优，2例良，3例差，优良率为75.00%；11例带蒂皮瓣修复患者中有5例患者达到优，3例良，3例差，优良率为72.72%；27例局部皮瓣修复患者中有16例患者达到优，8例良，3例差，优良率为88.89%。三组患者优良率比较差异无统计学意义(P>0.05)。结论：拇指皮肤软组织缺损患者皮瓣修复手术应根据拇指缺损的程度及医疗水平进行选择，最大限度地恢复拇指的功能及外观。
【关键词】拇指；皮肤软组织缺损；皮瓣修复；修复方法；效果
Clinical Study of Effect and Method of Skin Flap Repair on Thumb Soft Tissue Defects/LI Run-chao，XIONG Bing-gang，LI Ming-hua.//Medical Innovation of China，2012，9(11)：053-054
【Abstract】Objective：To study effect and method of skin flap reparing on thumb soft tissue injury.Methods：From March 2009 to November 2011，50 patients with thumb soft tissue defect in our hospital were divided into three groups，and treated with free skin flap repair， local skin flap repair and pedicled skin flap repair，respectively.Effect of three groups were compared.Results：Of 12 patients treated with free skin flap repair，excellent in 7 cases，good in 2 cases，poor in 3 cases，the excellent and good rate was 75.00%.Of 11 patients treated with pedicle flap repair，excellent in 5 cases，good in 3 cases，poor in 3 cases，the excellent and good rate was 72.72%. Of 27 patients treated with local skin flap repair，excellent in 16 cases，good in 8 cases，poor in 3 cases，the excellent and good rate was 88.89%.The difference of excellent and good rate in three groups was not statistical significant(P>0.05).Conclusion：The operation method of skin flap repair on thumb soft tissue defect should be based on the defect degree and medical level，and to maximize the recovery of function and appearance of the thumb.
【Key words】Thumb;Skin soft tissue defects;Skin flap repair; Repair method;Effect
First-author’s address： Shilong People’s Hospital of Dongguan，Dongguan 23320，China
doi：10.3969/j.issn.1674-4985.2012.11.031
在手外伤中，损伤为常见的创伤。因拇指在全手活动功能中占重要的地位，与其他手指配合完成捏、持、抓、握等活动，所以应慎重考虑手术方式对拇指活动、长度、感觉、外观等方面的影响。选取本院2009年3月-2011年11月50例拇指皮肤软组织缺损患者，对皮瓣修复方法进行研究，现报告如下。
1资料与方法
1.1一般资料选取2009年3月-2011年11月于本院进行治疗的50例拇指皮肤软组织缺损患者，其中女18例，男32例，年龄18~64岁，平均(36.4±3.1)岁。其中6例(12%)为电锯伤，14例(28%)为挤压伤，30例(60%)为冲压伤。
1.2手术方法常用的拇指皮肤软组织缺损皮瓣修复方法有三种：(1)游离皮瓣：采用踇趾腓侧游离皮瓣或踇甲皮瓣；(2)带蒂皮瓣：采用断蒂皮瓣(腹部带蒂皮瓣及邻指皮瓣)或不断蒂皮瓣(拇指背神经营养皮瓣)；(3)局部皮瓣：采用局部转移皮瓣(双蒂转移皮瓣或单蒂转移皮瓣) ......
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