【作者】 陈越林；

【导师】 李明；

【作者基本信息】 山东大学 ， 外科学， 2010， 硕士

【摘要】 目的探讨带血管神经蒂的大鱼际桡侧逆行岛状瓣修复拇指软组织缺损的效果。方法2001年～2008年,共修复拇指末节软组织缺损71例。分别应用腹部皮瓣12例、食指背侧岛状皮瓣16例、拇指桡背侧皮瓣15例、大鱼际桡侧逆行岛状瓣13例、游离趾腹皮瓣15例修复缺损。大鱼际桡侧逆行岛状瓣应用13例中,男10例,女3例；年龄22～51岁,平均32.4岁。伤因：电锯伤4例,电刨伤4例,挤压伤3例,切割伤2例。6例为指腹缺损；5例为指端缺损。皮瓣设计在大鱼际区桡侧,以桡侧指动脉为蒂,在指间关节近侧转位。皮瓣面积最大4.1×2.8cm,最小2.2×1.5cm,10例行皮神经与指神经吻合。术后10天开始功能锻炼。71例全部进行随访,随访内容包括拇指的色泽、外形、质地、出汗情况及综合感觉,拇指指腹痛觉、触觉、两点辨别觉及运动功能等。71例患者通过手术时间、术中出血量及综合感觉进行比较。结果71例皮瓣全部成活。食指背侧皮瓣平均手术时间38min,出血20ml；拇指桡背侧皮瓣平均手术时间45min,术中出血25ml；拇桡侧大鱼际肌皮瓣平均手术时间42min,出血29ml；腹部皮瓣平均手术时间39min,出血80ml；游离趾腹皮瓣平均手术时间300min,出血165ml。游离趾腹皮瓣的手术时间、出血量与其他4种方法比较有显著差异。术后随访12～18个月,平均15个月。以最后一次复查为准,食指背侧皮瓣综合质地的优良率62.5%；拇指桡背侧皮瓣的优良率80%；拇桡侧大鱼际肌皮瓣的优良率84.6%；腹部皮瓣的优良率25%；游离趾腹皮瓣的优良率86.7%。大鱼际桡侧逆行岛状皮瓣修复后的皮肤色泽、外形、质地、出汗及综合质地感觉均优于腹部皮瓣及食指背侧皮瓣,与拇指桡背侧皮瓣、趾腹游离皮瓣优良率相似。结论应用带血管神经蒂的大鱼际桡侧逆行岛状瓣修复拇指软组织缺损,操作简单,血供可靠,能恢复感觉,修复后功能及外形均满意。更多还原

【Abstract】 Objective:Objective To explore the effect of greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defectMethods:from 2001 to 2008,71 cases distal thumb sofe tissue defect was repared:Abdominal flap 12 cases The index finger dorsal island flap 16 cases, thumb at palmar side island flap15 cases,, greeter thenar palmar reversed island flapl3cases,the big toe skin flap 15 cases 13 cases was used to greeter thenar palmar reversed island flap male10 case, femal 3case, Aged 22 to 51 years old, mean age 32.4 years Injury due to Saw 4 cases, planer in 4 cases,3 cases of crush injury, cuts 2.6 cases of pulp defect; 5 with fingertip defect The flap was devised at the greater thenar with pedicle of thumb radialpalmar artery.The rotation point was proximal to the interphalangeal joint..The flap ranged from4.1×2.8cm to 2.2x 1.5cm connecting neurocutaneous and finger nerve for 10 cases.and summarized after ten days the results of 71 patients whose data were completely acquired,according to the shapes,sweating sensory and motor functions etc.71 patients, by operative time, blood loss and comprehensive sense to compareResults:71 patients with flaps all survived. Index finger dorsal flap mean operative time 38min, bleeding 20ml; thumb dorsal radial flap mean operative time was 45min, blood loss was 25ml; thumb radial thenar flap mean operative time was 42min, bleeding 29ml; abdominal flap average operative time 39min, bleeding 80ml; free toe pulp flap mean operative time was 300min, bleeding 165ml. thenar palmar reversed island flap operation time, blood loss compared with the other four kinds of methods were significantly different. Were followed up for 12 to 18 months, an average of 15 months. Subject to final review, the index finger the fine texture of dorsal skin flap rate of consolidated 62.5%; thumb dorsal radial flap of the superior rate of 80%; thumb radial thenar flap fine rate was 84.6%; abdominal flap 25% good; free toe flap of excellent and good rate was 86.7%, The shapes,sweating and sensory of the thumb pulp with greeter thenar palmar reversed island flap were excellent to Abdominal flap The index finger dorsal island flap, and similar to thumb at ulnar side island flap, greeter thenar palmar reversed island flap,the big toe skin flapConclusion:The greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defect has advantages of simple performance and reliable blood supply and reconstruct its sensation.更多还原