V-Y推进皮瓣在指端皮肤缺损临床应用体会[1]

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1、V-Y推进皮瓣在指端皮肤缺损临床应用体会[1]栏目：临床研究栏目审稿意见：1请作者按照编辑提示的更改内容修改。2请按照编辑提示修改。3全稿请作者自检无误（重点检查参考文献引用位置标注）后发回编辑部。4基木意见：可刊用。V-Y推进皮瓣在指端皮肤缺损的临丿木应用体会施保华【摘要】冃的：探讨V-Y推进皮瓣在指端皮狀缺损修复的适应症和手术方法及应用体会。方法：2005年1月一2010年6月，收治126例指端皮肤缺损伤患者。伤因:挤压伤39例，切割伤67例，电锯伤20例。伴有指甲甲板脱落46例。损伤类型:横断面48指、偏背侧25指、偏掌侧44指、侧方缺损37指

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4、1.0cmX1.2cm〜1.5cmX2.5cnio伤后至手术时间3〜10h°改良的指腹V-Y皮瓣66例,改良的Kutlerv-y皮瓣41例，应用Leonard的V—Y“CUP”瓣11例，改良的Moberg带指神经血管束的v-y皮瓣23例。联合皮瓣13例。合并甲床损伤的一期修补，甲板打孔原位缝合。结果：2-3周内愈合拆线；3例伤口感染4周愈合；2例皮瓣部分坏死换药6周愈合；1例皮缘发黑未做处理，后期随访8周愈合。患者均获随访，随访时间2〜6个刀，平均3.5个月。皮瓣外形饱满、质软，朕色和皮温均正常。46例甲板脱落患者除1例术后出现钩甲畸形

5、，余指甲光滑、无压痛，甲床平整无甲棘；患指各关节活动无影响。结论：对指端皮肤缺损根据损伤类型和缺损而积采用不同的修复方法，有利于最人程度恢复指尖功能和外形。严格掌握不同V-Y推进皮瓣手术适应症，熟悉手术解剖和手术技能是减少皮瓣坏死发生率的重要因素。【关键词】指端缺损V-Y皮瓣甲床回植【中图分类号】R658.2【文献标识码】C【文章编号】1008-6455(2010)THECLINICALEXPERIENCESOFUSINGV-YADVANCEFLAPFORTHEREPAIROFTHEFINGERTTPDEFECTSillBaohuaDepartmen

6、tofOrthopedics,ThePeople"sHospitalofBaoZhen;ChongMing;ShangHai;202157DepartmentofSurgery,TheResearchAndAdvancedStudiesClassOfGrade09,TheMedicalCollegeOfTongJiUniversity;Shanghai;[Abstract】ObjectiveToinvestigatetheclinicalexperiencesofusingdifferentv-yadvanccflapfortherepairofth

7、efingerstipdefect・MethodsFromJanuary2005toJune2010,126casesof154fingerswithfingertipdefect,including76males83fingersand50females71fingers,aged7-76years,weretreated.126patients(39crushinjuries,67cuttinginjuriesond20sawinginjuries)wereclassifiedinto4types,48fingerswithtraverseamp

8、utationinjuries,25fingerswithpartialbacksidedefect,44fingerswithpartialslapdefect,37fingerswithprofiledefect.Thesofttissuedefectrangedfrom1.0cmX1.2cmtoL5cmX2.5cm.Thetimefrominjurytosurgerywas3T0hours.66fingersusingtheamelioratedfingerabdomenv-yadvanceflap,41fingersusingtheameli

9、oratedKutlerv-yadvanceflap,11fingersusingLeonardv-ycupadvanceflap,23fingersusingtheamelioratedMobergcontainNervesandbloodvesselsv-yadvaneeflap,13fingersusingthecompoundedv-yadvaneeflap.Emergednai1bedinjuriesshouldbefirsttimepatchedup,thenakednailbedshouldbecoveredwithopenednail

10、deck・Results120patientsincisionshealedbyfirstintention