Jiang Hao, Li Qing Feng, Gu Bin, Fu Kaiding, Zheng Danning, Liu Kai, Shen Guoxiong
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Second Medical University, Shanghai, People's Republic of China.
Ann Plast Surg. 2008 Jun;60(6):626-30. doi: 10.1097/SAP.0b013e318137a49e.
To explore the possibility of a one stage restoration of protective sensation and finger flexion after electrical burn of the hand, 5 patients with electrical injuries at the wrist were treated by a new free composite flap, originating from the medial lateral crural skin flap. This flap can repair skin, blood vessels, tendons, and nerves in a one-stage procedure. The harvest of the medial lateral crural flap is described. The posterior tibial vessels provide the arterial supply. The perforators to the flap and the branches to the plantaris tendon and the sural nerve were preserved, and the nerve and tendon were kept within the flap by careful dissection of the crural fascia. At the same time, 3 to 4 tendons of extensor digitorum longus were inserted into the layer between superficial and profundus crural fascia. Thus, blood vessels, nerves, and tendons were combined into the flap before transplantation. The composite flap was then transplanted into the recipient site of the injured hand to repair the complex defects in a single operation. Flexion and extension function of the fingers was evaluated. Sensory function was tested by the standards recommended by the British Medical Research Council System for evaluating sensibility. Follow-up ranged from 18 to 24 months. Results revealed all flaps survived. The flexion distance from tip to palmar crease and extension distance from tip to horizontal level of 3 patients were 4 to 5 cm and 3 to 4 cm, respectively. At 6 months, 2 patients improved from 6 cm and 5 cm to 4 cm and 4 cm, respectively. The sensation reached to S2 level, and skin temperature rose. The medial lateral crural composite flap is an ideal, one-stage method to restore protective sensation and finger flexion for advanced-stage patients who have suffered severe high voltage electrical injuries in the wrist.
为探讨手部电烧伤后一期恢复保护性感觉和手指屈曲功能的可能性，对5例腕部电损伤患者采用一种源自小腿内外侧皮瓣的新型游离复合组织瓣进行治疗。该组织瓣可一期修复皮肤、血管、肌腱和神经。文中描述了小腿内外侧皮瓣的切取方法。胫后血管提供动脉血供。保留皮瓣的穿支、至跖肌腱和腓肠神经的分支，并通过仔细解剖小腿筋膜将神经和肌腱保留在皮瓣内。同时，将3～4条趾长伸肌腱插入小腿浅、深筋膜之间。这样，血管、神经和肌腱在移植前就组合在皮瓣内。然后将复合组织瓣移植到伤手的受区，一次性修复复杂缺损。评估手指的屈伸功能。采用英国医学研究委员会系统推荐的标准测试感觉功能。随访时间为18～24个月。结果显示所有皮瓣均存活。3例患者手指从指尖到掌横纹的屈曲距离和从指尖到水平位的伸展距离分别为4～5 cm和3～4 cm。6个月时，2例患者分别从6 cm和5 cm改善至4 cm和4 cm。感觉恢复到S2级，皮温升高。小腿内外侧复合组织瓣是一种理想的一期修复方法，可为腕部遭受严重高压电损伤的晚期患者恢复保护性感觉和手指屈曲功能。
