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吻合血管的足趾皮瓣修复手指软组织缺损

报道46例手指中、末节损伤所致皮肤、指甲缺损，采用吻合血管的趾部皮瓣、皮甲瓣移植修复，全部成活。经4个月～36个月随访，外形及功能均满意。介绍了手术方法，供区选择原则。讨论了手术的优点及应注意的问题。

手指 NORA 病三例诊疗分析

目的 分析 Nora 病的临床病理特点及诊疗方法。 方法 回顾分析 2009 年 5 月—2015年 1 月收治的 3 例 Nora 病患者临床资料，其中男 2 例，女 1 例；年龄 49～56 岁。X 线片及 CT 示指骨周围钙质密度影，MRI 呈中等 T1 信号、T2 高信号。完整切除肿块及包膜，见骨性组织块及颗粒物。病理检查见异型软骨细胞、高分化梭形细胞、骨软骨界面蓝色着色和散在的双核或离奇放大的软骨细胞。 结果 术后分别随访 1.2、2.5、3.2 年。复查 X 线片示骨皮质光滑，无复发。 结论 对 Nora 病需加强认识，其病理特征独特，术后应密切随访是否复发。

拇手指再造75例86指

利用并指加皮瓣移植法修复多个手指皮肤缺损

1987年～1990年,应用并指加皮瓣移植方法修复多个手指掌侧或背侧皮肤软组织缺损7例,均恢复了较好的外形与功能。讨论了手术要点,皮瓣选择,分指时机及功能训练等。

REPLANTATION OF SEGMENTAL DESTRUCTIVE AMPUTATION OF MULTIPLE FINGERS

OBJECTIVE: To discuss the indication of replantation of destructive amputation of multiple fingers for improvement of the function of injured fingers. METHODS: From February 1996 to August 1999, 23 amputated fingers in 8 cases were shortened and replanted. The crushed digital bones were fixed by Kirschner wires, flexor tendons repaired by Kessler suture technique, and digital extensor tendons repaired by mattress suture. The arteries and veins were anastomosed in each finger at the ratio of 1 to 2 or 2 to 3. The defect of blood vessels was repaired by free graft of autologous veins in 5 fingers. All of the cases were followed up for 10 to 18 months, and clinical evaluation was performed. RESULTS: All replanted fingers survived in the 8 cases, with good sensation, two point discrimination of 6 to 12 mm, and satisfied function, such as pinching, grasping and hooking. The fingers were shortened for 2.6 cm in average, ranging from 2.2 cm to 4.0 cm. CONCLUSION: Multiple digits replantation by shortening fingers is beneficial to functional restoration of segmental destructive fingers.

尺动脉腕上皮支游离皮瓣修复手指掌侧软组织缺损

目的 总结尺动脉腕上皮支游离皮瓣修复第2～5指掌侧皮肤软组织缺损的临床效果。 方 法 2003 年5 月－ 2009 年10 月，收治第2 ～ 5 指掌侧皮肤软组织缺损17 例19 指。男12 例，女5 例；年龄21 ～ 53 岁，平均38.6岁。机器伤12 例，交通事故伤3 例，切割伤2 例。损伤指别：示指5 例，中指6 例，环指4 例，小指4 例；其中2 例为相邻两指。14 例为急性损伤，伤后至入院时间为10 min ～ 7.5 h；3 例为伤后彻底清创后感染创面。创面范围5.0 cm × 1.5 cm ～ 7.5 cm × 4.5 cm。应用大小为6.5 cm × 2.5 cm ～ 9.0 cm × 6.0 cm 的尺动脉腕上皮支游离皮瓣修复缺损，供区直接缝合或游离植皮修复。 结果 术后1 ～ 6 d 4 例出现表皮张力性水疱，3 例皮瓣远端部分坏死，经对症处理后皮瓣成活；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区切口均Ⅰ期愈合，植皮均成活。术后14 例获随访，随访时间6 个月～ 2 年6 月，平均1.3 年。皮瓣外形、质地、色泽均满意，两点辨别觉8 ～ 20 mm。手指功能参照关节主动活动度法（TAM）评定，获优8 例，良5 例，可1 例。 结论 尺动脉腕上皮支游离皮瓣是修复第2 ～ 5 指掌侧皮肤软组织缺损的有效方法之一。

PATHOGENESIS OF SWAN-NECK DEFORMITY OF FINGERS AFTER BURN AND ITS TREATMENT

The surgical treatment of 20 cases (58 fingers) of swan-neek deformity of fingers after burns was reported. The operativc techniques included: (1) The cicatrix at the dorsal aspect of the finger was relcased and the raw surface thus formed was covered by skin graft, while the palmar skin was tightened; (2) Thc extensor mechanism of the finger was partially resected with relcase of the interosscous muscles and shortening of tcnodesis of the tendon of flexor digitorum superficialis; and (3) Fusion of the interphalangeal joint. The results of various methods of treatment were analyzed, and the pathogenesis of swan-neck deformity of fingers was discussed. The importance of prevention of its occurrence was emphasized.

CLINICAL APPLICATION OF VASCULARIZED SKIN FLAP WITH NERVE (REPORT OF 10 CASES)

The digital defects which severely interfered with the hand functions must be reconstructed. The primary repair by vascularized skin flap with the dorsal branch of proper palmar digital nerve could be done. The vascularized flap was rich in blood circulation, perfect sensibility and a good contour, as well as preserving donor digital sensation. However, it was simple, safe, and with higher success. From 1989 to 1991, 10 cases of digital defects were treated, all of the patients gained very good results. The indication and technique of thismethod wasdiscussed in detail.

拔伸牵引延长术治疗手指部分缺失

报道30例手指或拇指部分缺失患者,采用自制的拔伸牵引器延长手指或拇指。平均延长2.93cm。采用自体骨或同种异体冷冻骨植骨,平均7.8周骨愈合。延长的手(拇)指感觉、功能均好。介绍了手术操作,讨论了手术适应证、操作注意事项及并发症的防治等。

真皮下血管网皮瓣修复手指脱套伤38例

目的 探讨手部脱套伤中皮肤缺损的修复方法。 方法 1998年5月～2005年5月，根据手部脱套伤的皮肤缺损面积、形状设计髂腹股沟真皮下血管网皮瓣修复38例46指。其中拇指11指，食指20指，中指9指，无名指4指，小指2指，拇指、食指同时脱套伤3例。手术均一期修复，切取皮瓣为6 cm×2 cm～17 cm×8 cm。供区直接缝合9例，中厚皮片修复29例。 结果 46指皮瓣全部成活，术后10～12 d断蒂。供区创面均Ⅰ期愈合。获随访6～12个月，手部外形、功能满意。两点辨别觉＞10 mm。 结论 应用真皮下血管网皮瓣修复手指脱套伤具有操作简便，安全性高，实用性强，适于基层医院开展。