Yongwei Pan, Jianing Wei, Junhui Zhao, Guanglei Tian, Wen Tian, Chun Li
Department of Hand Surgery, Jishuitan Hospital, #31 Xinjiekou Dongjie, Beijing 100-035, People's Republic of China.
J Hand Surg Am. 2004 Mar;29(2):209-15. doi: 10.1016/j.jhsa.2003.12.004.
To present a random-pattern flap technique using scarred skin from the abdominal wall to cover the defect after burn scar was released from the hand and the scarred skin raised from the hand was transferred to the abdominal wall to cover the flap-donor area in patients who suffered from severe burns involving the entire body and had no available healthy skin to be used for coverage.
Ten hands of 7 patients (5 males, 2 females) were treated in our department between April 1994 and February 2001. The total body surface area involved with second-or third-degree burns was 85% to 96% and there was no available healthy skin to be used for reconstruction. All hands had severe scar contracture on the dorsum and lost most of their function and the patients lost the ability to take care of themselves. The scarred skin on the dorsum of the hand was elevated integrally as a flap based on the ulnar border of the hand. The tendons were released, the stiff metacarpophalangeal joints were mobilized by closed capsulotomies, and the contracture of the thumb web space was released. A random-pattern abdominal flap using scarred skin was designed and elevated to cover the defect of the scar-released hand and the scarred skin raised from the dorsum of the hand was transferred to cover the defect of the abdominal flap donor site.
The flaps that were transferred to the dorsum of the hands survived entirely and the defects of the flap donor area were covered perfectly without further skin graft. All patients were evaluated for 0.5 to 4 years after surgery. The range of motion of the metacarpophalangeal joints and the space capacity of the thumb web were improved greatly. All patients regained the ability to take care of themselves.
This method is simple and has satisfactory results. It appears from our experience that the mature postburn scarred skin on the abdomen can be used for a flap procedure for reconstructing the burned hand and that the scarred skin raised from the dorsum of the hand can be transferred to cover the flap donor sites on the abdomen. Under circumstances in which there is no normal skin for reconstruction the function of the burned hand could be improved greatly by this method.
介绍一种随机皮瓣技术，即利用腹壁瘢痕皮肤覆盖手部烧伤瘢痕松解后的缺损，同时将手部掀起的瘢痕皮肤转移至腹壁覆盖皮瓣供区，用于治疗全身重度烧伤且无可用健康皮肤进行覆盖的患者。
1994年4月至2001年2月，我科共治疗7例患者（男5例，女2例）的10只手。患者全身Ⅱ度或Ⅲ度烧伤总面积为85%至96%，无可用健康皮肤进行重建。所有手部背部均有严重瘢痕挛缩，大部分功能丧失，患者失去自理能力。以手部尺侧缘为蒂，将手背瘢痕皮肤整块掀起形成皮瓣。松解肌腱，通过闭合性关节囊切开术活动僵硬的掌指关节，并松解拇指蹼间隙挛缩。设计并掀起一块利用瘢痕皮肤的随机腹壁皮瓣，覆盖手部瘢痕松解后的缺损，将手部背部掀起的瘢痕皮肤转移至腹壁覆盖皮瓣供区缺损。
转移至手部背部的皮瓣全部存活，皮瓣供区缺损无需进一步植皮即可完美覆盖。所有患者术后随访0.5至4年。掌指关节活动范围及拇指蹼间隙容量均有明显改善。所有患者均恢复了自理能力。
该方法操作简单，效果满意。根据我们的经验，腹部成熟的烧伤后瘢痕皮肤可用于手部重建的皮瓣手术，手部背部掀起的瘢痕皮肤可转移至腹壁覆盖皮瓣供区。在无正常皮肤进行重建的情况下，该方法可显著改善烧伤手部的功能。
