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硅胶带修复四肢皮肤软组织缺损16例

足踝部皮肤软组织缺损的修复

【摘 要】 目的 总结足踝部皮肤软组织缺损修复方法及疗效。 方法 2005 年8 月－ 2008 年8 月，收治46 例足踝部皮肤软组织缺损患者。男40 例，女6 例；年龄12 ～ 68 岁，平均35 岁。交通事故伤31 例，机器碾压伤6 例，医源性损伤2 例，电击伤1 例，糖尿病足溃疡6 例。缺损范围4 cm × 2 cm ～ 27 cm × 16 cm。病程4 h ～ 2 年。采用股前外侧游离皮瓣12 例，腓肠神经营养血管皮瓣25 例，胫后动脉逆行皮瓣1 例，隐神经皮瓣2 例，腓动脉终末穿支皮瓣2 例，交腿皮瓣1 例，足底内侧皮瓣2 例，跖背皮瓣1 例，皮瓣切取范围4 cm × 3 cm ～ 28 cm × 18 cm；供区直接缝合或中厚皮片游离移植修复。 结果 术后46 例患者均获随访，随访时间6 个月～ 3 年，平均11 个月。术后10 d 2 例腓肠神经营养血管皮瓣发生远端部分坏死；其余皮瓣均成活，创面Ⅰ期愈合。供区植皮均成活，无明显挛缩；切口Ⅰ期愈合。术后6 个月，1 例采用腓肠神经营养血管皮瓣修复的足底创面发生小面积溃疡，经对症处理后愈合；其余患者皮瓣质地、色泽正常。患者可负重行走，步态正常。 结论 合理采用局部带蒂皮瓣或游离皮瓣修复足踝部皮肤缺损，可明显缩短病程，达到保肢保足目 的。

前臂桡侧逆行岛状皮瓣修复虎口皮肤及软组织缺损一例

皮肤伸展术在皮肤软组织缺损中的临床应用

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.

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。

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.

颈背扩张皮瓣修复前额部皮肤软组织缺损

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。

游离前臂骨间背侧皮瓣修复手指皮肤软组织缺损

【摘 要】 目的 总结游离前臂骨间背侧皮瓣修复手指皮肤软组织缺损的疗效。 方法 2008 年7 月－ 2010 年5 月，收治12 例12 指手指皮肤软组织缺损患者。男9 例，女3 例；年龄17 ～ 35 岁，平均24.5 岁。机器挤压伤3 例，电刨伤5 例，电锯伤4 例。示指7 例，中指4 例，环指1 例。创面缺损范围为3 cm × 2 cm ～ 4 cm × 2 cm。受伤至手术时间 3 ～ 8 h，平均 4 h。采用大小为3.5 cm × 2.5 cm ～ 4.5 cm × 2.5 cm 的游离前臂骨间背侧皮瓣移植修复创面，将皮瓣携带的骨间背侧动、静脉与受区指固有动脉或指总动脉、指背静脉或掌背远端浅静脉吻合。供区直接拉拢缝合。 结果 术后7 d，1 例皮瓣近端坏死，经换药后愈合；其余皮瓣均顺利成活，创面及供区切口均Ⅰ期愈合。患者均获随访，随访时间6 ～ 12 个月,平均9 个月。皮瓣质地优良，局部无臃肿，耐磨无溃疡。术后6 个月皮瓣两点辨别觉为8 ～ 10 mm，平均 9.3 mm。术后6个月手指功能按照中华医学会手外科学会上肢功能评定试用标准评定，获优 4 例，良 6 例，可 2 例。 结论 应用游离前臂骨间背侧动脉皮瓣移植修复手指皮肤软组织缺损可获得较好临床效果。