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前臂桡侧逆行岛状皮瓣修复虎口皮肤及软组织缺损一例

多块掌背动脉岛状皮瓣修复多指皮肤软组织缺损

目的 总结多块掌背动脉岛状皮瓣修复多指皮肤软组织缺损的疗效。 方法2009年7月－2011年8月，采用多块掌背动脉岛状皮瓣修复多指皮肤软组织缺损16例。男11例，女5例；年龄17～69岁，平均38岁。掌侧缺损4例，背侧缺损12例。软组织缺损范围1.0 cm × 0.5 cm～5.5 cm × 2.5 cm。伤后至入院时间为30 min～8 h，平均3 h。皮瓣切取范围1.2 cm × 1.0 cm～6.5 cm × 3.0 cm。供区拉拢缝合或植皮修复。 结果术后1例皮瓣远端坏死，1例皮瓣轻度感染，均经换药后成活；其余皮瓣及供区植皮均成活，切口均Ⅰ期愈合。术后16例患者均获随访，随访时间6～24个月，平均12个月。皮瓣外形、质地良好，末次随访时皮瓣两点辨别觉为7～11 mm；手指功能根据中华医学会手外科学会上肢部分功能评定试用标准：获优9例，良6例，可1例，优良率为93.8%。 结论利用掌背动脉、掌心动脉及掌侧指总动脉交通支相吻合的解剖特点，选择其各自走行上的掌背皮瓣修复多指皮肤软组织缺损，具有手术操作简便、安全、可靠等优点。

封闭式负压引流技术联合腓肠神经营养血管逆行岛状皮瓣修复下肢皮肤软组织大面积缺损

目的 总结封闭式负压引流技术（vacuum sealing drainage，VSD）联合腓肠神经营养血管逆行岛状皮瓣修复下肢皮肤软组织大面积缺损的临床疗效。 方法 2008 年1 月－ 7 月，收治25 例下肢皮肤软组织大面积缺损患者。男13 例，女12 例；年龄15 ～ 54 岁，平均34.4 岁。机器绞伤15 例，交通伤9 例，爆炸伤1 例。损伤部位：小腿中下段8 例，踝部4 例，足背部5 例，足跟部及跟腱部8 例。创面范围为9 cm × 4 cm ～ 12 cm × 9 cm。受伤至手术时间为1 ～ 12 h，平均6.2 h。先行VSD 治疗待创面肉芽组织新鲜、感染控制后，采用大小为10 cm × 7 cm ～ 13 cm × 11 cm 的腓肠神经营养血管逆行岛状皮瓣修复创面。供区直接缝合或游离植皮修复。 结果 皮瓣修复术后2 例出现皮瓣切口远端皮缘坏死，1 例静脉危象，经对症处理后成活；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区切口均Ⅰ期愈合，游离植皮成活。25 例均获随访，随访时间11 ～ 14 个月，平均13 个月。皮瓣与周围皮肤色泽相似，无臃肿，质地佳；皮瓣受力处无破溃。 结论 VSD 治疗能降低创面感染几率，为皮瓣修复提供良好组织床。腓肠神经营养血管逆行岛状皮瓣是修复下肢及远端足跟部皮肤软组织缺损的有效方法之一。

双叶穿支皮瓣修复指背软组织缺损

目的总结指背双叶穿支皮瓣修复指背软组织缺损的临床疗效。 方法2015年3月-2016年3月，采用指背双叶穿支皮瓣修复指背软组织缺损13例。男6例，女7例；年龄19～66岁，平均31.7岁。致伤原因：机器冲压伤9例，重物压伤4例。受伤至入院时间40 min～36 h，平均7.4 h。指别：示指3指，中指5指，环指5指。缺损范围1.0 cm×1.0 cm～2.5 cm×2.0 cm。第1皮瓣覆盖缺损创面，第2皮瓣覆盖第1皮瓣供区，第2皮瓣供区直接缝合。 结果术后创面均Ⅰ期愈合。皮瓣均顺利成活，无血管危象发生。12例患者获随访，随访时间3～9个月，平均5.5个月。各皮瓣色泽红润、质地良好；第l皮瓣供区无凹陷、破溃，第2皮瓣供区线性瘢痕愈合，整体外观良好。末次随访时按手指主动活动度（TAM）法评定手功能：优9指、良3指。 结论采用指背双叶穿支皮瓣修复指背创面缺损，手术操作简便，疗效较好。

皮肤伸展术在皮肤软组织缺损中的临床应用

颈背扩张皮瓣修复前额部皮肤软组织缺损

Effectiveness analysis of disposable skin stretch closure in treatment of difficult to close skin and soft tissue defects

Objective To observe the effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close. Methods The clinical data of 13 patients with skin and soft tissue defects that were difficult to close treated with disposable skin stretch closure and met the selection criteria between July 2021 and February 2022 were retrospectively reviewed. There were 9 males and 4 females, the age ranged from 15 to 71 years with a mean of 39.8 years. The causes of injury included falling injury in 5 patients, traffic accident injury in 5 patients, and falling from height injury in 3 patients. The causes of skin soft tissue defects included open fractures in 4 patients, wound infection in 4 patients, osteomyelitis in 3 patients, degloving injury in 1 patient, and necrosis of skin graft in 1 patient. The injury was located at calf in 8 patients, calcaneus in 3 patients, pelvis in 1 patient, and plantar in 1 patient. The skin and soft tissue defects ranged from 5.0 cm×2.0 cm to 10.5 cm×6.5 cm. Wound conditions (wound closure and wound healing) and the presence or absence of complications were recorded. Results All 13 patients were followed up 32-225 days with a median of 164 days. The wound closure time ranged from 5 to 14 days, with a mean of 8.8 days. The wound closure speed ranged from 0.7 to 13.7 cm2/day, with a mean of 3.6 cm2/day. All wounds healed at grade A, and no complication such as skin edge injury, wound necrosis, infection, dehiscence, and edema occurred. No patient complained of pain or discomfort, and no obvious scarring was found during follow-up. The wound healing time ranged from 17 to 28 days, with a mean of 21.7 days. One of them was transferred to other department due to lung cancer condition changes after using disposable skin stretch closure, and the wound had directly healed without suturing at 17 days after operation. Conclusion The effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close was exact, with short wound closure time, few complications, and easy operation.

Clinical application of medial sural artery perforator flap in the repair of small and medium size skin and soft tissue wounds of ipsilateral lower limbs

Objective To investigate the therapeutic effect of medial sural artery perforator flap in the repair of small and medium size skin and soft tissue defects in the ipsilateral lower extremities. Methods The clinical data of patients with small and medium area skin and soft tissue defects of lower limbs admitted to Restorative and Reconstructive Department, NO.1 Orthopedics Hospital of Chengdu between September 2021 and January 2023 was retrospectively analyzed. Basic information of patients was collected. The anatomical characteristics, application methods, and clinical results of the flap were recorded after operation, and the comprehensive efficacy evaluation table of the flap was used to evaluate the clinical efficacy at the last follow-up. Results A total of 13 patients were included. There were 12 males and 1 female. A total of 19 perforating branches of medial sural artery were found in the 13 cases, with an average of 1.46 perforating branches. The incision range of the flap was 5.5 cm×3.5 cm−13.5 cm×5.0 cm. Anterograde pedicle metastasis occurred in 3 cases and free transplantation occurred in 10 cases; mosaic flaps were used in 5 cases, lobed flaps in 1 case, and conventional perforator flaps in the remaining 7 cases. All the flaps survived successfully. All the 13 patients were followed up for 4-15 months, with an average of (10.38±3.64) months. The comprehensive score of flap efficacy was 77-92 points, with an average of (86.76±4.45) points. Among them, 5 cases were excellent, 8 cases were good, and the excellent and good rate was 100%. Conclusion The multifunctional features and flexible use of medial sural artery perforator flap increase the repair strategy of small and medium-sized wounds of the ipsilateral lower limbs, and can obtain better aesthetic repair results.

硅胶带修复四肢皮肤软组织缺损16例

APPLICATION OF VENOUS Flow-through FLAP IN FINGER REPLANTATION WITH CIRCULARITY SOFT TISSUE DEFECT

ObjectiveTo investigate the treatment outcome of applying venous Flow-through flap in the replantation of severed finger with circularity soft tissue defect and vascular defect. MethodsBetween January 2010 and December 2012,11 cases (11 fingers) of severed finger with circularity soft tissue defect and vascular defect underwent replantation with venous Flow-through flaps.There were 8 males and 3 females,aged 18-42 years (mean,24.6 years).The cause of injury was squeeze injury in 6 cases,crush injury in 3 cases,and strangulation in 2 cases.Combined injuries included nerve defect in 3 cases (1.0,2.0,and 3.5 cm in length),and tendon defect in 2 cases (2.0 and 6.5 cm in length); cyclic skin and soft tissue defect was 3.0-4.5 cm in width,was 1/2-1 finger circumference in length,and was 2.0 cm×1.0 cm to 7.0 cm×4.5 cm in size.Six cases had complete circular defect (both finger artery and vein defects),and 5 cases had incomplete circular defect (only finger artery defect),and vascular defect was 1.0-4.5 cm in length.The time from injury to operation was 1.5-4.5 hours. ResultsVenous crisis occurred in 1 case at 2 days after operation,was cured after vein graft; flap edge necrosis was observed in 2 cases and was cured after dressing change and skin grafting respectively; flap edema and blister occurred in 2 cases and relieved spontaneously.The other 6 flaps and replanted fingers survived completely,with primary healing of incision.Ten cases were followed up 12-18 months (mean,15.5 months).Only a linear scar was seen at the donor sites,with no functional limitation.The flaps had similar color and texture to adjacent skin.The two-point discrimination was 6.5-13.0 mm (mean,8.6 mm).According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association,the results were excellent in 6 cases,good in 3 cases,and poor in 1 case at last follow-up,and the excellent and good rate was 90%. ConclusionVenous Flow-through flap can repair both vascular defect and soft tissue defect,so it has good outcome in increasing the survival rate of replanted finger for severed finger replantation with circularity soft tissue defect and vascular defect.