Henry Mark
Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA.
J Reconstr Microsurg. 2007 Feb;23(2):59-62. doi: 10.1055/s-2007-970183.
Major trauma to the digit that includes skin degloving and tendon loss, as well as fractures, nerve segmental loss, and devascularization can render that digit chronically painful, stiff, insensate, and a detriment to the overall function of the hand to the point that such digits may be candidates for ray resection. Large wounds may exceed the ability to achieve coverage by regional pedicle flaps. When the wound is restricted to the level of the digit, the narrow cylindrical shape and the ability to flex and fold make an absolute requirement for a very thin, as well as supple, flap a requirement that cutaneous free flaps cannot meet. This series reports on 12 male patients with major degloving and structural trauma at the digit level in which bone, tendon, and nerve reconstructions were covered with free fascial flaps and immediate split-thickness skin grafts, followed by early rehabilitation. All patients achieved sufficient functional recovery so that subsequent surgeries were not indicated.
手指遭受的严重创伤，包括皮肤脱套伤和肌腱缺失，以及骨折、神经节段性缺失和血运障碍，可导致该手指长期疼痛、僵硬、感觉丧失，并对手部整体功能造成损害，以至于这些手指可能成为截指的对象。大的伤口可能超出局部带蒂皮瓣覆盖的能力。当伤口局限于手指水平时，手指狭窄的圆柱形形状以及屈伸和折叠的能力使得绝对需要一块非常薄且柔软的皮瓣，而这是游离皮瓣无法满足的要求。本系列报道了12例男性患者，他们在手指水平遭受了严重的脱套伤和结构性创伤，其中骨、肌腱和神经重建采用游离筋膜皮瓣覆盖并即时进行中厚皮片移植，随后进行早期康复治疗。所有患者均实现了足够的功能恢复，因此无需进行后续手术。
