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[腕部穿支游离皮瓣修复电烧伤后手指创面的临床效果]

[Clinical effects of repair of wounds in fingers after electrical burn with wrist perforator free flaps].

作者信息

Di H P, Xia C D, Xing P P, Li Q, Han D W, Xue J D, Cao D Y

机构信息

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2017 Sep 20;33(9):557-561. doi: 10.3760/cma.j.issn.1009-2587.2017.09.007.

Abstract

To explore the clinical effects of repair of wounds in the fingers after electrical burn with wrist perforator free flaps. Twelve patients (13 fingers) with electrical burn were hospitalized in our burn ward from January 2016 to January 2017. After radical debridement, the size of wounds ranged from 5.0 cm×2.0 cm to 10.0 cm×7.0 cm. Wounds with size below or equal to 6.0 cm ×2.5 cm were repaired with free flaps based on the superficial palmar branch of radial artery, with flap area ranging from 2.5 cm×2.2 cm to 6.0 cm×4.5 cm. The superficial palmar branch of radial artery, subcutaneous vein, and palmar cutaneous branch of the median nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly. Wounds with size larger than 6.0 cm×2.5 cm were repaired with free flaps based on the dorsal carpal branch of ulnar artery, with flap area ranging from 4.5 cm×3.0 cm to 12.0 cm×8.5 cm. The dorsal carpal branch of ulnar artery, subcutaneous vein, and medial antebrachial cutaneous nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly or covered by full-thickness skin graft from abdomen. Five free flaps based on the superficial palmar branch of radial artery and 8 free flaps based on the dorsal carpal branch of ulnar artery were used in the patients. In one week after surgery, 12 flaps survived completely, while one free flap based on the dorsal carpal branch of ulnar artery suffered from slight infection, after depressing change, it survived in the end. After the follow-up of half a year, the flaps were full in shape and the distance of two-point discrimination of ranged from 4.0 to 7.0 mm. The fingers showed good functional recovery and no deformity. The grade of function of the fingers was excellent in 10 cases and good in 3 cases. There were small incision scars in donor sites. The wrist perforator free flap is safe and reliable for repairing electrical burn wound of finger. The wounded finger shows good appearance and function after operation.

摘要

探讨腕部穿支游离皮瓣修复手指电烧伤创面的临床效果。2016年1月至2017年1月,12例(13指)手指电烧伤患者入住我院烧伤病房。彻底清创后,创面大小为5.0 cm×2.0 cm至10.0 cm×7.0 cm。创面大小小于或等于6.0 cm×2.5 cm者,采用以桡动脉掌浅支为蒂的游离皮瓣修复,皮瓣面积为2.5 cm×2.2 cm至6.0 cm×4.5 cm。桡动脉掌浅支、皮下静脉、正中神经掌皮支分别与手指指固有动脉、指背浅静脉、指固有神经行端端吻合。供区直接缝合。创面大小大于6.0 cm×2.5 cm者,采用以尺动脉腕背支为蒂的游离皮瓣修复,皮瓣面积为4.5 cm×3.0 cm至12.0 cm×8.5 cm。尺动脉腕背支、皮下静脉、前臂内侧皮神经分别与手指指固有动脉、指背浅静脉、指固有神经行端端吻合。供区直接缝合或用腹部全厚皮片覆盖。患者共使用5块以桡动脉掌浅支为蒂的游离皮瓣和8块以尺动脉腕背支为蒂的游离皮瓣。术后1周,12块皮瓣完全成活,1块以尺动脉腕背支为蒂的游离皮瓣发生轻度感染,经换药后最终成活。随访半年,皮瓣外形丰满,两点辨别觉为4.0至7.0 mm。手指功能恢复良好,无畸形。手指功能评级优10例,良3例。供区有小切口瘢痕。腕部穿支游离皮瓣修复手指电烧伤创面安全可靠。术后伤指外形及功能良好。

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