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find Author "刘跃飞" 7 results
  • EFFECTIVENESS OF FREE FLAPS IN REPAIR OF HOT-CRUSH INJURY IN DORSUM OF HAND

    Objective To evaluate the effectiveness of free flaps in repairing hot-crush injury in the dorsum of hand. Methods Between February 2003 and February 2012, 32 cases of hot-crush injuries in the dorsum of hand were repaired. There were 25 males and 7 females with an average age of 24 years (range, 16-45 years). The injury causes included machine crush injury in 9 cases, machine-press injury in 13 cases, and iron panel injury in 10 cases. The time from injury to admission ranged from 90 minutes to 8 hours (mean, 3 hours). The wound size ranged from 6 cm × 5 cm to 17 cm × 11 cm. Associated injuries included the extensor tendon necrosis in 12 cases, and the second metacarpal bone necrosis in 1 case. One-stage emergency debridement was performed in all cases; two-stage flap repair was given at 7-21 days when the necrotic area became determined. The dorsalis pedis flaps were used in 9 cases, the anterolateral thigh flaps in 9 cases, the latissimus dorsi flaps in 3 cases, the thoraco-umbilical flaps in 3 cases, and the lower abdominal flaps in 8 cases. The flap size ranged from 7 cm × 5 cm to 18 cm × 16 cm. The donor site was repaired by skin graft or sutured directly. Results All the flaps survived. Primary healing of wound was obtained in 25 cases and delayed healing in 7 cases. Skin graft at donor site survived, with healing of incision by first intention. Twenty-three cases were followed up 6-25 months (mean, 13 months). Thinning was carried out in 8 bulky flaps; the other flaps had good appearance and texture. At last follow-up, the range of motion (ROM) of the metacarpophalangeal joint ranged from 40 to 80° (mean, 58°); ROM of the proximal interphalangeal joint ranged from 35 to 70° (mean, 52°); and ROM of the distal interphalangeal joint ranged from 5 to 25° (mean, 12°). The sensation recovery of the flaps were more than S2. No scar formed at donor site. Conclusion Suitable free flap should be selected to repair hot-crush injury in the dorsum of hand according to size of wound, which will achieve satisfactory results.

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • NEUROVASCULAR FREE FLAP BASED ON DORSAL BRANCH OF DIGITAL ARTERY OF RING FINGER FOR FINGER PULP DEFECT

    Objective To investigate the surgical procedures and cl inical outcomes of the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect. Methods From February 2006 to May 2009, 11 cases (11 fingers) of finger pulp defect with tendon and bone exposure were treated, including 8 males and 3 females with an average age of 29 years (range, 23-40 years). The defect locations were thumb in 2 cases, index finger in 5 cases, and middle finger in 4 cases. The defect size ranged from 1.0 cm × 1.0 cm to 2.5 cm × 2.0 cm. The time frominjury to operation was 1-9 hours. The flap size ranged from 1.5 cm × 1.5 cm to 3.0 cm × 2.5 cm. Five flaps carried the dorsal branch of digital nerve, 6 flaps carried nervi digitales dorsales. The flaps were cut from proximal radial dorsal ring finger in 4 cases and from promximal ulnar dorsal ring finger in 7 cases. Defect of donor site was repaired with full-thickness skin grafting. Results All flaps and grafted skins survived; wound and incision of donor site achieved heal ing by first intention Eleven patients were followed up 6 to 24 months with an average of 12 months. The other finger flaps had good texture and shape except for 1 flap with sl ightly bloated. The activities of finger distal interphalangeal joint were normal, the two-point discrimination of finger pulp was 7-12 mm. The extension and flexion activities of donor fingers were normal, the ringl ike thread scar left at the donor site. Conclusion It is an ideal method to use the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect, which has the advantages of simple operation, good appearance, and functional recovery.

    Release date:2016-08-31 05:48 Export PDF Favorites Scan
  • RECONSTRUCTION OF METACARPOPHALANGEAL JOINT DEFECT BY THE SECOND TOE PROXIMAL INTERPHALANGEAL JOINT WITH SKIN FLAPS

    Objective To invest igate the operat ive method and cl inical ef f icacy of reconstruct ing metacarpophalangeal joint defect by the second toe proximal interphalangeal joint with skin flaps. Methods From March 2003 to January 2008, 26 cases (26 fingers) with metacarpophalangeal joint defect were treated, including 19 males and 7 females aged 18-36 years old (average 27 years old). Among them, 23 cases were caused by mechanical injury and the time from injury to operation was 1-6 hours; while 3 cases suffered from secondary injury due to trauma and the time from injury to operation was 3-12 months. Four thumbs, 10 index fingers, 8 middle fingers, 3 ring fingers and 1 l ittle finger were injured.The metacarpophalangeal joint defects were 2 cm × 1 cm-4 cm × 2 cm in size, and 22 cases were combined with skin and soft tissue defect (1.5 cm × 1.5 cm - 6.0 cm × 5.0 cm). During operation, the second toe proximal interphalangeal joint with skin flaps was transplanted to reconstruct those defects, 20 fingers received whole-joint transplantation and 6 fingers received halfjoint transplantation. The skin flaps ranging from 2.0 cm × 1.5 cm to 6.5 cm × 6.0 cm in size were adopted. The donor site of 21 cases received toe amputation, and the rest 5 cases received joint fusion. Results The transplanted joints and skin flaps of all the 26 fingers survived. All incisions and donor sites healed by first intention. All patients were followed up for 6-20 months (average 12 months). The union of transplanted joints was achieved in all the cases at 6-12 weeks after operation, no bone nonunion and refracture occurred. The flexion range of transplanted metacarpophalangeal joints was 30-75° (average 45°). Joint activity was evaluated according to the total active movement/total passive movement assessment criteria, 8 fingers were excellent, 13 good, 3 fair, 2 poor, and the excellent and good rate was 80.77%. The foot donor-site abil ity to walk was unaffected. Conclusion Applying second toe proximal interphalangeal joint with skin flaps is an effective approach to reconstruct the metacarpophalangeal joint defect, and the function recovery of the injured joints is satisfying.

    Release date:2016-09-01 09:05 Export PDF Favorites Scan
  • 前臂外侧皮神经营养血管远端蒂皮瓣修复手部皮肤软组织缺损

    目的 总结应用前臂外侧皮神经营养血管远端蒂皮瓣修复手部皮肤软组织缺损的手术方法及临床疗效。 方法 2004 年10 月- 2008 年2 月,采用前臂外侧皮神经营养血管远端蒂皮瓣修复手部皮肤软组织缺损31 例。男25 例,女6 例;年龄29 ~ 65 岁,平均41 岁。挤压伤11 例,冲床压伤7 例,齿轮绞伤4 例,热压伤1 例,外伤后虎口挛缩8 例。软组织缺损范围为4 cm × 3 cm ~ 11 cm × 8 cm。除虎口挛缩患者外,余患者受伤至手术时间为1 ~ 15 h,平均4 h。术中皮瓣切取范围为4.5 cm × 3.0 cm ~ 12.0 cm × 9.0 cm。供区直接缝合或全厚皮片植皮。 结果 术后1 例头静脉未行处理者于术后24 h 出现皮瓣颜色青紫、张力升高,经对症处理2 周后皮瓣成活;其余皮瓣顺利成活,伤口均Ⅰ期愈合。供区伤口均Ⅰ期愈合,植皮均顺利成活。25 例获随访,随访时间6 ~ 36 个月,平均13 个月。皮瓣质地良好。按照皮瓣感觉恢复分级标准测定:6 例恢复S3+,19 例恢复S3。供区手腕关节功能正常。 结论 采用前臂外侧皮神经营养血管远端蒂皮瓣修复手部皮肤软组织缺损,操作简便、安全,是修复手部中小面积皮肤软组织缺损的一种良好方法。

    Release date:2016-09-01 09:07 Export PDF Favorites Scan
  • REPAIR OF WHOLE-HAND DESTRUCTIVE INJURY AND HAND DEGLOVING INJURY WITH TRANSPLANT OF PEDIS COMPOUND FREE FLAP

    Objective?To investigate the surgical method and clinical efficacy of repairing whole-hand destructive injury or hand degloving injury with the transplant of pedis compound free flap.?Methods?From February 2003 to June 2008, 21 patients with whole-hand destructive injury or hand degloving injury were treated, including 15 males and 6 females aged 18-45 years old (average 25 years old). The injury was caused by punching machine crush in 10 cases, roller crush in 7 cases, and imprinter crush in 4 cases. The time between injury and operation was 1-9 hours. Eleven cases had the skin-degloving injury of the whole hand, while the other 10 cases had the proximal palm injury combined with dorsal or palmar skin and soft tissue defect. After debridement, the size of wound was 9 cm × 7 cm - 15 cm × 10 cm in the dorsal aspect and 10 cm × 7 cm -16 cm × 10 cm in the palmar aspect. The defect was repaired by the thumbnail flap of dorsalis pedis flap and the second toenail flap of dorsalis pedis flap in 5 cases, the thumbnail flap of dorsalis pedis flap and the second toe with dorsalis pedis flap in 4 cases, and bilateral second toe with dorsalis pedis flap in 12 cases. The flap area harvested during operation ranged from 6 cm × 5 cm to 16 cm × 11 cm. Three fingers were constructed in 2 cases and two fingers in 19 cases. Distal interphalangeal joint toe amputation was conducted in the thumbnail flap donor site, metatarsophalangeal joint toe amputation was performed in the second toenail flap donor site, and full-thickness skin grafting was conducted in the abdomen.?Results?At 7 days after operation, the index finger in 1 case repaired by the second toenail flap suffered from necrosis and received amputation, 1 case suffered from partial necrosis of distal dorsalis pedis flap and recovered after dressing change, and the rest 42 tissue flaps survived. Forty-three out of 44 reconstructed fingers survived. All the wounds healed by first intention. At 2 weeks after operation, 2 cases had partial necrosis of the donor site flap and underwent secondary skin grafting after dressing change, the rest skin grafts survived, and all the wounds healed by first intention. Nineteen cases were followed up for 6-36 months (average 11 months). The flaps of palm and dorsum of hand showed no swelling, the reconstructed fingers had a satisfactory appearance and performed such functions as grabbing, grasping, and nipping. The sensory of the flaps and the reconstructed fingers recovered to S2-S4 grade. The donor site on the dorsum of the foot had no obvious scar contracture, without obvious influence on walking.?Conclusion?For the whole-hand destructive injury or hand degloving injury, the method of transplanting pedis compound free flap can repair the defect in the hand and reconstruct the function of the injured hand partially. It is an effective treatment method.

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • 指背神经营养血管远端筋膜蒂皮瓣修复手指末节创面

    目的 总结指背神经营养血管远端筋膜蒂皮瓣修复手指末节创面的方法及效果。 方法 2003 年2 月- 2008 年2 月,采用指背神经营养血管远端筋膜蒂皮瓣修复外伤所致手指末节创面765 例823 指。男535 例581指,女230 例242 指。年龄7 ~ 68 岁。指腹缺损或毁损197 指,手指Ⅰ度缺损285 指,Ⅱ度缺损204 指,甲床缺损112指,末节侧方缺损25 指。缺损范围1 cm × 1 cm ~ 3 cm × 3 cm。受伤至手术时间2 h ~ 2 周。术中切取皮瓣1.5 cm ×1.0 cm ~ 3.5 cm × 3.0 cm。供区取全厚皮片植皮修复。 结果 术后5 例5 指皮瓣部分坏死,对症处理后成活;其他皮瓣均顺利成活。68 例伤口Ⅱ期愈合,其余伤口均Ⅰ期愈合。供区植皮均成活,切口Ⅰ期愈合。术后521 例559 指获随访,随访时间4 ~ 36 个月,平均8 个月。皮瓣质软、无色素沉着。手指功能按照总主动活动度/ 总主动屈曲度标准评定,优232 例,良289 例。 结论 指背神经营养血管远端筋膜蒂皮瓣修复手指末节创面,具有操作简便、损伤小的优点。

    Release date:2016-09-01 09:07 Export PDF Favorites Scan
  • 手指指尖再造

    【摘 要】 目的 总结采用第2 足趾末节移植再造手指指尖缺损的方法及临床效果。 方法 2001 年4 月-2006 年12 月,收治17 例21 指手指指尖缺损患者。男10 例14 指,女7 例7 指;年龄18 ~ 32 岁。冲床压伤7 例,电刨伤5 例,机器绞伤2 例,其他伤3 例。示指10 指,中指7 指,环指4 指。均为手指甲根部以远缺损。术中切取第2 足趾末节,采用吻合指- 趾血管的方法重建血液循环行指尖再造。 结果 1 指于术后36 h 发生血管危象,经重新吻合术后12 d 手指成活,余再造指尖12 d 后均成活。供区伤口均Ⅰ期愈合。患者术后均获随访,随访时间5 个月~ 2 年,手指外形恢复良好,远侧指间关节活动度0 ~ 55°,指腹两点辨别觉4 ~ 6 mm。按中华医学会手外科分会再植与再造功能评定试用标准评定,均为优。供区行走功能无明显影响。 结论 第2 足趾末节移植再造手指指尖缺损是较理想方法之一。

    Release date:2016-09-01 09:14 Export PDF Favorites Scan
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