动脉化静脉皮瓣急诊修复手指软组织缺损

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1、中国修复重建外科杂志2008年6月第22卷第7期·797·动脉化静脉皮瓣急诊修复手指软组织缺损李瑞华阚世廉李明新【摘 要】目的总结逆静脉瓣供血、顺静脉瓣回流的动脉化静脉皮瓣急诊修复手指软组织缺损的临床效果。 方法 2002年10月－2007年3月，采用动脉化静脉皮瓣修复手指皮肤软组织缺损7例，男6例，女1例；年龄17～46岁。受伤原因：挤压伤6例，车床切削伤1例。受伤至手术时间2～7h。缺损范围3.0cm×2.0cm～6.0cm×3.5cm。均采用同侧前臂游离动脉化静脉皮瓣修复创面，皮瓣内静脉近心端分别与手指动、静脉吻合。切取皮瓣范围3.0cm×2.5cm～7.0cm×4.0cm。供区直接拉拢

2、缝合。 结果术后6例皮瓣完全成活，1例出现部分表皮坏死，脱痂后愈合。供区创面Ⅰ期愈合。术后随访3个月～4年，皮肤质地、厚薄均满意，仅1例表皮坏死者出现部分色素沉着。皮瓣均无硬化、挛缩和影响关节活动的现象。按中华医学会手外科学会上肢功能评定标准：优3指，良4指。 结论逆静脉瓣供血、顺静脉瓣回流的动脉化静脉皮瓣是目前修复手指软组织缺损的一种较理想方法。【关键词】动脉化静脉皮瓣手指软组织缺损修复中图分类号：R622.1 R658.2  文献标志码：APRIMARYREPAIROFSOFTTISSUEDEFECTINFINGERSWITHARTERIALIZEDVENOUSFLAP/LIRuihua,

3、KANShilian,LIMingxin.DepartmentofHandandMicrosurgery,TianjinHospital,Tianjin,300211,P.R.China.Correspondingauthor:LIRuihua,E-mail:liruihuatianjin@sina.com【Abstract】  Objective Tosummarizetheresultsofthefreetransplantationofanti-valve-inflowandpro-valve-outflowarterializedvenousflapinrepairingsofttis

4、suedefectoffingersinemergencytreatment.MethodsFromOctober2002toMarch2007,7casesofsofttissuedefectsoffingerswererepairedwitharterializedvenousflaps.Therewere6malesand1female,aged17-46years.Defectwascausedbycrushinjuryin6casesandbystabinjuryin1case.Theintervalbetweeninjuryandoperationwas2-7hoursandthe

5、sizeofdefectsrangedfrom3.0cm ×2.0cmto6.0cm ×3.5cm.Alldefectswererepairedbyarterializedfreevenousflapfromtheipsilateralforearm,inwhichtheproximalendsofveinswereanastomosedtoarteryandveinofthefinger.Thedonorsitewasdirectlysutured.ResultsSixcasesofarterializedvenousflapsurvivedcompletelyand1casehadpart

6、ialsuperficialnecrosisandhealedwithconservativemanagement.Thedonorsitehealedbyfirstintention.Postoperativefollow-uprangedfrom3monthsto4years,thetextureandthethicknessoftheflapsweresatisfactory,onlyonepresentedpartialpigmentdepositsbecauseofsuperficialnecrosis.Nosclerosis,contractureandlimitedrangeof

7、motionoccurredinallflaps.AccordingtotheevaluationcriteriaforupperlimbfunctionissuedbyHandSurgeryBranchofChineseMedicalAssociation,theresultswereexcellentin3casesandgoodin4cases.ConclusionItisanidealme