Elliot David, Adani Roberto, Hyun Woo Sang, Tang Jin Bo
1 Hand Surgery Department, Broomfield Hospital, Chelmsford, UK.
2 Department of Hand and Microsurgery, University Hospital Modena, Modena, Italy.
J Hand Surg Eur Vol. 2018 Dec;43(10):1019-1029. doi: 10.1177/1753193418805698.
We review recent developments in using occlusive dressings, dermal templates, and venous flaps for less invasive approaches to treat soft tissue defects of the forearm and fingers. Occlusive dressings can be used for thumb tip or fingertip trauma with soft tissue defects of small or moderate sizes. They permit skin regeneration without use of skin graft or a flap transfer. This is currently a popular way to treat tip soft tissue defects in European countries. Extensive soft tissue defects in the thumb, fingers, hand and forearm require flap transfers traditionally, but in recent years, surgeons use dermal templates to cover the defect site to allow regeneration of subcutaneous tissues, over which a skin graft is used in lieu of a flap. Transfer of a venous flap is currently a reliable procedure and is less invasive compared with conventional flaps, which usually damage a named artery in the donor. We advocate that less invasive methods should be considered for soft tissue defects in the hand and forearm.
我们回顾了使用封闭敷料、真皮模板和静脉皮瓣等微创方法治疗前臂和手指软组织缺损的最新进展。封闭敷料可用于拇指尖或指尖创伤且伴有中小面积软组织缺损的情况。它们无需植皮或皮瓣转移就能实现皮肤再生。目前，这是欧洲国家治疗指尖软组织缺损的常用方法。传统上，拇指、手指、手部和前臂的大面积软组织缺损需要进行皮瓣转移，但近年来，外科医生使用真皮模板覆盖缺损部位，以促进皮下组织再生，然后在此基础上使用植皮替代皮瓣。静脉皮瓣转移目前是一种可靠的手术方法，与传统皮瓣相比，其侵入性较小，传统皮瓣通常会损伤供区的一条知名动脉。我们主张，对于手部和前臂的软组织缺损，应考虑采用侵入性较小的方法。
