Shi Haifeng, Rui Yongjun, Shou Kuishui
Wuxi Hand Surgery Hospital, Wuxi Jiangsu, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006 Jul;20(7):728-31.
To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure.
From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoral flap (forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, which was used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9, right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hot pressing injury, 2 soft tissue defection of instep and plantae by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsal or combined with fingers of hand with skin defect; with perpendicular-shape flaps in 3 cases of dorsal combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsal combined with palms of feet; with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm x 4.8 cm to 17.0 cm x 12.0 cm, the sizes of lobulated flaps ranged from 3.5 cm x 2.8 cm to 7.5 cm x 4.5 cm.
All flaps survived without vascular crisis after operation. Except the fascia flap all recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hot pressing injury and 1 case of carding machine injury whose function was not satisfactory, the remaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.
The application of irregular anterolateral femoral flap is an optimal choice for complex skin defect of hand.
介绍一种一次性修复手部不同区域和不同部位软组织缺损的方法。
2002年5月至2005年5月，将股前外侧皮瓣或分叶股前外侧皮瓣（形成不规则股前外侧皮瓣）设计成不同形状，修复手部不同区域的多处软组织缺损，临床应用27例。27例中，男16例，女11例；部位：左手9例，右手16例，左足2例；包括穿透伤5例，热压伤9例，碾挫伤致足背及足底软组织缺损2例，绞轧伤6例，梳棉机伤5例。所有病例均合并肌腱、骨骼或关节外露。手掌穿透伤5例用H形皮瓣修复；手背或合并手指皮肤缺损11例用Y形或K形皮瓣修复；手背合并手掌侧或第一掌骨间隙皮肤缺损3例及手背合并足底皮肤缺损2例用垂直形皮瓣修复；手背或手掌合并手指皮肤缺损断开6例用h形皮瓣修复。主要皮瓣大小为6.5 cm×4.8 cm至17.0 cm×12.0 cm，分叶皮瓣大小为3.5 cm×2.8 cm至7.5 cm×4.5 cm。
术后所有皮瓣均存活，无血管危象发生。除筋膜皮瓣外，所有受区均一期愈合。随访3个月至1年，所有病例外观满意，皮瓣质地柔软。除2例穿透伤、3例热压伤和1例梳棉机伤功能不满意外，其余病例均达到捏取功能。术后1年以上，痛觉和触觉恢复。供区虽有部分病例形成瘢痕增生，但无功能障碍。
不规则股前外侧皮瓣的应用是手部复杂皮肤缺损修复的最佳选择。
