V-Y推进皮瓣在指端皮肤缺损临床应用体会

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1、V-Y推进皮瓣在指端皮肤缺损的临床应用体会施保华沈决心上海市崇明县堡袒人民医院骨科同济大学医学院09级研修班外科学202157【摘要】目的探讨V-Y椎进皮瓣在描瑞皮肤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例折•端皮肤缺损伤患者。伤因:挤压伤39例，切削伤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、偏背側25指、倔拿侧44指、侧方缺损37扌旨。缺扌贞范Bll.Ocmx1.2cm~1.5cmx2.5emo伤后至手术时间3~10h。

2、改良的指腹VY皮瓣66例.改良的Kutlervy皮諮4]例,应用Leonard的Y-Y“CUP”瓣11例，改便的Moberg带指神经血管束的v・y皮藤23例。联合皮瓣13例。合并屮床损伤的-，期修补，甲板打孔原位缝合。结果：2-3周内念合拆线；3例伤口感染4周愈合：2例皮蔚部分坏死换药6周愈合：1例皮缘发朋未做处理.后期随访8周金合•患者均获随访，随访时间2〜6个月.平肉3・5个月.皮瓣外形饱满、质软•肤色和皮温沟正常.46例甲板脫落患者除1例术后出现钩甲畸形，余指甲光泳无压痛.甲床平整无甲蜕患指

3、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面积采用不同的修复方法.有利于艰大程度恢更指尖功能和外形。严格堂握不同V-Y推进皮鍛手术适应症，熟悉手术解剖和手术技能是减少皮廉坏死发生率的垂要因索。【关键词】指端缺损T皮瓣甲床回植THECLINICALEXPERIENCESOFUSINGV-YADVANCEFLAPFORTHEREPAIROFTHEFINGERTIPDEFECTSHIBaohuaSHENJuexinDepartmentofOrthopedics.ThePeople'sHos

4、pitalofBaoZhcn;ChongMing;Shangllai;202157DepartnwniofSurgery,TheResearchAndAdvancedStudiesClassOfGrade09.TheMedicalCollegeOfTongJiUniversity:Shanghai:[?bstract]ObjectiveToinvestigatetheclinicalexperiencesofusingdifferentv-yadvaneoflapfortherepairofth

5、efingerstipdefect.MethodsFromJanuary2005toJune2010,126casesof154fingerswithfingertipdefect,including76males83fingersand5()females71fingers・aged7-76years・weretreated.126patients(39crushinjuries.67cuttinginjuriesand20sawinginjuries)wereclassifiedinto4ly

6、pcs.48fingerswithtraverseamputationinjuries,25fingerswithpartialbacksidedefect,44fingerswithpartialslapdefect.37fingerswithprofiledefect・Thesofttissuedefectntngcdfrom1.0cmxl.2cmto1.5cmx2.5cm.Thelimefrominjurytosurgerywas3-1()hours・66fingersusingtheame

7、lioratedfingerabdomenv-yadvanceflap,41fingersusingtheamelioratedKutlerv-yadvanceflap,11fingersusingLeonardv-ycupadvanceflap,23fingersusingtheamolioratedMobergcontainNervesandbloodvesselsv-yadvanceflap,13fingersusingthecompoundedv-yadvanceflap・Emergedn

8、ailbedinjuriesshouldbefirsttimepatchedup.thenakednai1bedshouldbecoveredwithopenednai1deck・Results120patientsincisionshealedbyfirstintention(removesewingthreadafter2-3weeks)andtheflaps,naikandskingraftingsurvived;3patientshealedupafter4weeksfor