Al-Qattan Mohammad M, Alammar Alwaleed K, Alfaqeeh Faisal A, Altamimi Lamees A, Alfehaid Norah S, Mahabbat Nehal A, Pant Rajeev
Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
Department of Plastic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Plast Reconstr Surg Glob Open. 2021 Mar 24;9(3):e3474. doi: 10.1097/GOX.0000000000003474. eCollection 2021 Mar.
Hand reconstruction using pedicled abdominal flaps has several disadvantages, including delayed hand therapy leading to stiffness.
This is a retrospective study of 70 cases of pedicled abdominal flaps used for hand reconstruction in adults in whom physiotherapy of the attached hand was implemented. The review aims to investigate the rate of flap dehiscence, infection, hematoma, and flap edge necrosis in our cases, and to establish that physiotherapy of the attached hand is not associated with an increased risk of complications. The review also aims to establish the effectiveness of physiotherapy of the attached hand in reducing the risk of stiffness by documenting the range of motion of the uninjured digits immediately after flap division and at final follow-up.
There were no cases of flap dehiscence, infection, or hematoma. Six cases had minor partial flap edge necrosis that was treated conservatively and allowed to heal by secondary intention. In 62 patients, the range of motion of the uninjured digits was 90%-100% of the normal range of motion at day 1 post-flap division, and all of these patients recovered a full range of motion (in the uninjured digits) within 2 weeks of follow-up. Eight patients were reluctant to do the exercises as instructed because of low pain threshold; 4 of these 8 patients had residual stiffness at the final follow-up.
The implementation of active exercises of the attached hand is feasible in selected cases and it helps minimize the risk of stiffness of the hand.
使用带蒂腹部皮瓣进行手部重建存在若干缺点，包括延迟手部治疗导致僵硬。
这是一项对70例用于成人手部重建的带蒂腹部皮瓣病例的回顾性研究，这些病例对手部进行了物理治疗。该综述旨在调查我们病例中皮瓣裂开、感染、血肿和皮瓣边缘坏死的发生率，并确定手部物理治疗与并发症风险增加无关。该综述还旨在通过记录皮瓣断蒂后即刻以及最终随访时未受伤手指的活动范围，确定手部物理治疗在降低僵硬风险方面的有效性。
没有皮瓣裂开、感染或血肿的病例。6例出现轻微的部分皮瓣边缘坏死，采用保守治疗，任其二期愈合。在62例患者中，皮瓣断蒂后第1天未受伤手指的活动范围为正常活动范围的90%-100%，所有这些患者在随访2周内（未受伤手指）恢复了全范围活动。8例患者因疼痛阈值低而不愿按指示进行锻炼；这8例患者中有4例在最终随访时有残留僵硬。
在选定病例中对手部进行主动锻炼是可行的，并且有助于将手部僵硬风险降至最低。
