科研之友
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摘要
目的: 探讨髂腹股沟皮瓣联合足底内侧动脉穿支皮瓣（medial plantar artery perforator flap，MPAP）瓦合修复多指Ⅲ～Ⅳ度缺损疗效。. 方法: 2018年1月—2019年6月，收治12例机器碾压伤导致的多指Ⅲ～Ⅳ度缺损患者。男9例，女3例；年龄16～42岁，中位年龄29岁。受伤至入院时间1～9 h，平均3 h。损伤指别：示、中指7例，中、环指4例，示、中、环指1例。手指缺损按照顾玉东等提出的分度标准：Ⅲ度16指，Ⅳ度9指。急诊彻底清创后，创面封闭式负压引流处理；清创至皮瓣修复时间为12～36 h，平均18 h。一期切取髂骨搭建骨支架、近趾间关节重建近指间关节、髂腹股沟皮瓣和MPAP再造手板，髂腹股沟皮瓣切取范围为7.0 cm×4.5 cm～14.0 cm×9.0 cm，MPAP切取范围为8.0 cm×4.5 cm～14.0 cm×6.5 cm。腹部供区直接缝合，足底供区全厚皮片植皮。二期予以分指及皮瓣修整塑形。. 结果: 所有皮瓣全部成活，创面Ⅰ期愈合；供区切口Ⅰ期愈合，植皮完全成活。患者均获随访，随访时间12～18个月，平均16个月。末次随访时，患指质地柔软，外观及色泽接近健侧手指，皮瓣两点辨别觉为6～10 mm，平均8 mm；感觉恢复至S 3～S 4。按照密歇根大学手功能问卷（MHQ）评分达优8例、良4例。供区均未出现并发症。. 结论: 髂腹股沟皮瓣与MPAP瓦合修复手指Ⅲ～Ⅳ度缺损，手指质地、感觉及活动良好，足部供区损伤小。.Objective: To investigate the effectiveness of groin flap combined with medial plantar artery perforator flap (MPAP) for degree Ⅲ-Ⅳ defects of multiple fingers. Methods: Between January 2018 and June 2019, 12 patients with degree Ⅲ-Ⅳ defects of multiple fingers caused by crushing were admitted. There were 9 males and 3 females with a median age of 29 years (range, 16-42 years). The mean interval between the injury and admission was 3 hours (range, 1-9 hours). The injured fingers of 7 cases were index and middle fingers, 4 cases were middle and ring fingers, and 1 case was index, middle, and ring fingers. All fingers were taken thorough debridement and covered by the vacuum sealing drainage device during the emergency operation. The mean interval between the debridement and flap repairing was 18 hours (range, 12-36 hours). During the first-stage operation, the iliac bone graft was used to reconstruct bone frame, and the proximal interphalangeal (PIP) joint from the foot was transferred as the digital PIP joint, then the thin groin flap and MPAP were tailored to cover the dorsal and palmar defects, respectively. The size of the groin flap was 7.0 cm×4.5 cm-14.0 cm×9.0 cm, and the size of the MPAP was 8.0 cm×4.5 cm-14.0 cm×6.5 cm. The abdominal donor site was directly sutured, and the foot was repaired with full-thickness skin grafting. The flaps were separated into the finger shape at the second-stage. Results: All the flaps survived, and the wounds healed by first intention; the incisions in the donor site healed by first intention, and the skin grafts survived completely. All patients were followed up 12-18 months (mean, 16 months). At last follow-up, the injured finger was similar to the contralateral one in terms of texture, appearance, and color. The mean two-point discrimination was 8 mm (range, 6-10 mm), and the sensate level recovered to the S 3-S 4. According to the Michigan Hand Outcomes Questionnaire (MHQ), the reconstructed hand function was excellent in 8 cases and good in 4 cases. There was no complication in the donor sites. Conclusion: The degree Ⅲ-Ⅳ defects of multiple fingers were repaired by the groin flap and MPAP, and the reconstructed fingers can perform good texture and motion with being sensate, with less sacrifice on the foot.
