足微型游离皮瓣移植修复手指肌腱及骨质外露的全层电烧伤创面的疗效观察

[Curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers].

作者信息

Xue J D, Di H P, Liang Y, Xing P P, Guo H N, Zhao X K, Wang L M, Xia C D

机构信息

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

出版信息

Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 Aug 20;39(8):724-730. doi: 10.3760/cma.j.cn501225-20230323-00094.

Abstract

To explore the curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers. A retrospective observational study was conducted. From July 2017 to February 2022, 20 patients with full-thickness electric burn wounds deep to tendon or even bone in fingers who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 19 males and 1 female, aged 18 to 64 years. Among the 20 wounds, 15 wounds were located on the palm side, including 8 on the thumb, 5 on the index finger, and 2 on the middle finger; 5 wounds were located on the back, including 1 on the index finger and 4 on the middle finger. After debridement, the wound area ranged from 4.5 cm×2.0 cm to 7.0 cm×3.0 cm. According to the principle of tissue structure similarity, 10 wounds were repaired with plantar medial flaps, 5 wounds were repaired with hallux peroneal flaps, and 5 wounds were repaired with dorsalis pedis artery flaps, with flap area of 5.0 cm×2.5 cm-8.0 cm×3.5 cm. The flaps were transplanted freely and arteries and veins and/or nerves were anastomosed at the same time. The wound in the donor site was repaired with thigh medium-thick skin graft. The survival of flaps and skin grafts were observed after surgery. The appearance of flap, temperature and color of the distal end in the affected finger were observed during follow-up. At the last follow-up, the joint function and flap sensory recovery of the affected finger were evaluated with the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; the two-point discrimination distance of skin in the area of flaps with nerve anastomosis was measured; the satisfaction of patients with the curative effect was investigated by using the curative effect satisfaction rating scale, and the very satisfied rate was calculated; the repair effect of flap was evaluated by the comprehensive evaluation scale, and the excellent and good rate was calculated. All the flaps and skin grafts survived after surgery. During the follow-up of 10-18 months after surgery, the appearance of flap was natural and not bloated; the temperature and color of the distal end in the affected finger were basically the same as that of normal finger skin. At the last follow-up, the function recovery of the affected finger joints was as follows: 11 affected fingers were within the normal range of motion, 6 affected fingers had their total active range of motion recovered to 85% of the healthy side, and 3 affected fingers had their total active range of motion recovered to 75% of the healthy side; the flap sensory recovery was as follows: the sense of 15 flaps with nerve anastomosis all recovered to grade S3, and the two-point discrimination distance of skin in the flap area was 7.0-9.0 mm; the sense of 1 flap without nerve anastomosis recovered to grade S2 and the sense of 4 flaps recovered to grade S1. The satisfaction with curative effect of 20 patients was very satisfied in 16 cases and moderately satisfied in 4 cases, with the very satisfied rate of 80%; the repair result of 20 flaps was excellent in 16 cases, good in 2 cases, and fair in 2 cases, with excellent and good rate of 90%. Due to the similar tissue structure of donor site and recipient site, foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers can achieve good appearance and function, with better functional and sensory recovery of the affected finger in the case of nerve anastomosis. Patients have high degree of satisfaction with the curative effects, which is worthy of promotion.

摘要

探讨足部微型皮瓣游离移植修复手指肌腱及骨深度全层电烧伤创面的疗效。进行回顾性观察研究。2017年7月至2022年2月,郑州人民医院收治符合纳入标准的手指肌腱及骨深度全层电烧伤患者20例,其中男19例,女1例,年龄18~64岁。20处创面中,15处位于手掌侧,其中拇指8处,示指5处,中指2处;5处位于手背,其中示指1处,中指4处。清创后创面面积为4.5 cm×2.0 cm至7.0 cm×3.0 cm。根据组织结构相似原则,10处创面采用足底内侧皮瓣修复,5处创面采用拇腓侧皮瓣修复,5处创面采用足背动脉皮瓣修复,皮瓣面积为5.0 cm×2.5 cm - 8.0 cm×3.5 cm。皮瓣游离移植并同时吻合动静脉和/或神经。供区创面采用大腿中厚皮片修复。术后观察皮瓣及皮片存活情况。随访期间观察皮瓣外观、患指末端温度及颜色。末次随访时,按照中华医学会手外科学分会上肢功能评定试用标准评价患指关节功能及皮瓣感觉恢复情况;测量吻合神经皮瓣区皮肤两点辨别觉距离;采用疗效满意度评分量表调查患者对疗效的满意度,计算非常满意率;采用综合评价量表评价皮瓣修复效果,计算优良率。术后所有皮瓣及皮片均存活。术后10~18个月随访,皮瓣外观自然,无臃肿;患指末端温度及颜色与正常手指皮肤基本相同。末次随访时,患指关节功能恢复情况:11个患指关节活动度在正常范围内,6个患指关节总主动活动度恢复至健侧的85%,3个患指关节总主动活动度恢复至健侧的75%;皮瓣感觉恢复情况:15个吻合神经皮瓣感觉均恢复至S3级,皮瓣区皮肤两点辨别觉距离为7.0~9.0 mm;1个未吻合神经皮瓣感觉恢复至S2级,4个皮瓣感觉恢复至S1级。20例患者对疗效满意度:非常满意16例,中度满意4例,非常满意率为80%;20个皮瓣修复结果:优16例,良2例,可2例,优良率为90%。由于供区与受区组织结构相似,足部微型皮瓣游离移植修复手指肌腱及骨深度全层电烧伤创面可获得良好外观及功能,吻合神经时患指功能及感觉恢复更佳。患者对疗效满意度高,值得推广。

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