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尺动脉腕上皮支双叶游离皮瓣修复手指复杂创面

目的 总结尺动脉腕上皮支双叶游离皮瓣修复手指复杂创面的方法和临床效果。 方法 2009年5 月－2012年5月，对12例手指复杂创面患者采用以尺动脉腕上皮支为蒂，分别以其上行支和下行支为轴心血管的双叶游离皮瓣修复。其中男7例，女5例；年龄20～45岁，平均31岁。手指脱套伤2例，相邻两指软组织缺损4例，一指两处缺损6例。缺损范围6.0 cm × 1.5 cm～10.0 cm × 3.0 cm。皮瓣切取范围为上叶5.0 cm × 2.0 cm～8.0 cm × 4.0 cm，下叶3.5 cm × 1.8 cm～6.0 cm × 3.0 cm。供区直接缝合或游离植皮修复。 结果 1例术后12 h出现动脉危象，1例上叶皮瓣远端表皮部分坏死，经相应处理后愈合；其余皮瓣及供区植皮均顺利成活，切口Ⅰ期愈合。11例获随访，随访时间6～18个月，平均11个月，皮瓣颜色及质地与周围正常皮肤相似，手指外形满意。手指恢复部分浅感觉，两点辨别觉为6～8 mm，平均7 mm。术后6个月，按中华医学会手外科学会上肢部分功能评定试用标准评定，获优7例，良3例，中1例，优良率90.9%。 结论 尺动脉腕上皮支的上、下行支管径与指血管匹配，以此为蒂的双叶游离皮瓣修复后外观、感觉恢复满意，是修复手指复杂创面的理想方法之一。

残存环指掌指关节远尺侧半关节修复中指尺侧半关节一例

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足母 趾腓侧皮瓣修饰性修复拇手指掌侧皮肤缺损

【摘 要】 目的 介绍一种修复拇、手指掌侧皮肤缺损的理想手术方法。 方法 2001 年7 月－ 2006 年7 月，采用足母 趾腓侧皮瓣游离移植修复拇、手指掌侧皮肤缺损28 例。男16 例，女12 例；年龄14 ～ 46 岁。挤压伤11 例，冲床伤7 例，刀具割伤3 例，火器伤3 例，咬伤2 例，慢性溃疡2 例。拇指4 例，示指7 例，中指7 例，环指6 例，小指4 例。皮肤缺损2.0 cm × 1.5 cm ～ 4.0 cm × 2.5 cm。病程3 h ～ 7 d。皮瓣切取范围2.5 cm × 1.5 cm ～ 4.5 cm × 2.5 cm。供区直接缝合或全厚植皮修复。 结果 术后28 例供受区伤口均Ⅰ期愈合，移植皮瓣及供区植皮均成活。28 例获随访6 个月～ 5 年。皮瓣外形逼真，有罗纹，质地良好，两点辨别觉4 ～ 6 mm。按中华医学会手外科学会上肢部分功能评定试用标准：优25 例，良3 例。供足行走、跑、跳功能正常。 结论 足母 趾腓侧皮瓣修复拇、手指掌侧皮肤缺损，供区损伤小，对受区周围组织破坏小，修复后效果佳，能达到修饰性修复目的。

指动脉逆行皮瓣与邻指皮瓣瓦合修复单指中远节皮肤缺损

同指带蒂筋膜瓣修复甲床及指背皮肤软组织缺损

PRIMARY REPALR OF SEVERE INJURIES OF THUMB BY TRANSFER OF PEDICLED ISLAND FLAP

Since 1985, 76 pedicled island flaps had been used for primary repair of skin defect of thumb and 62 flaps for reconstruction of thumb. Fifteen thumbs were reconstructed by 29 pedicled island flaps in which 14 from dorsum of middle phalanx of index and middle fingers, 12 reversed island flaps from forearm and 3 from dorsum of proximal phalanx of index fingers. Eight degloved injuries of thumbs were repaired by 8 reversed island flaps from forearm. Thirty-nine skin defects of thumbs were treated by pedicled island flaps in which 16 from dorsum of proximal phalanx of indcx finger and 23 from dorsum ofmiddle phalanx of index and middle fingers.

Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion

Objective To investigate the effectiveness of transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion. Methods Between January 2007 and May 2015, 23 patients with thumb nerve avulsion were treated by transferring the ulnaris proper digital nerve of index finger and its dorsal branch. There were 17 males and 6 females with an average age of 32 years (range, 16-63 years). The injuries were caused by machine twist in 10 cases, electric saw in 8 cases, and sharp article prick in 5 cases. And thumb rotational avulsion amputation happened in 8 cases, thumb incomplete amputation in 2 cases, laceration of thumb palmaris with the thumb nerve avulsion of both sides in 13 caese (7 cases with tendon rupture). The time from injury to operation was 1.0-3.5 hours (mean, 2.2 hours). Results All incisions healed by first intention. Ten cases of thumb reimplantation were successful. All the patients were followed up for 5 months to 2 years and 8 months, with an average of 1 year and 4 months. Two-point discrimination was 3-9 mm (mean, 6.8 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the sensory of the thumb was rated as S4 in 18 cases and \begin{document}${{\rm{S}}_{\scriptsize{3^ + }}}$\end{document} in 5 cases; the sensory at donor sites recovered to S3. Conclusion Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion is a simple and effective method to restore sensory function of the thumb pulp.

Application of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect

Objective To investigate the effectiveness of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect. Methods Between February 2013 and July 2016, 11 cases (11 fingers) of mid-phalanx degloving injury with distal segment finger defect were treated. There were 9 males and 2 females with an average age of 33.6 years (range, 18-59 years). The injury caused by twisting in 8 cases and crushing in 3 cases. The injury located at index finger in 3 cases, middle finger in 6 cases, and ring finger in 2 cases. The skin avulsion was from proximal interphalangeal joint in 1 case, proximal 1/4 of mid-phalanx in 6 cases, and 1/2 of mid-phalanx in 4 cases. The area of wounds ranged from 4.0 cm×1.7 cm to 6.2 cm×2.6 cm. The interval between injury and operation was 2.5-6.0 hours (mean, 4.5 hours). All defects were repaired with the ipsilateral digital proper artery dorsal branch flaps. The size of flaps ranged from 4.4 cm×1.9 cm to 7.0 cm×2.9 cm. Nerve anastomose was carried between digital proper nerve dorsal branch in the flap and digital proper nerve stump in the wound. The donor sites were repaired by skin grafting. Results Tension blisters of the flap and partial necrosis occurred in 1 case, and healed after dressing change. The other flaps and skin grafting survived, and wounds healed by first intention. All patients were followed up 6-18 months (mean, 16 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination of flaps ranged from 7 to 10 mm (mean, 8.5 mm). At last follow-up, according to the functional assessment criteria of upper limbs by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 10 cases and good in 1 case, with the excellent and good rate of 100%. Conclusion The ipsilateral digital proper artery dorsal branch flap is a good method to repair mid-phalanx degloving injury with distal segment finger defect for the advantages of simple operation, less damage in donor site, high survival rate of the flap, and good feeling recovery of the finger.

动静脉转流术结合拔甲在幼儿 Ishikawa Ⅱ区断指再植中的应用

目的 总结动静脉转流术结合拔甲用于幼儿 Ishikawa Ⅱ区断指再植中的疗效。 方法 2013 年 9 月—2018 年 3 月，采用动静脉转流术结合拔甲对 23 例远端无静脉吻合条件的幼儿 IshikawaⅡ区断指进行再植。男 16 例（19 指），女 7 例（7 指）；年龄 1～3 岁，平均 2.3 岁。致伤原因：门挤压伤 8 例，重物压砸伤 7 例，机器轧伤 3 例，机械绞伤 5 例。伤指指别：示指 8 指，中指 10 指，环指 8 指。受伤至手术时间 3～9 h，平均 4.7 h。 结果 术后 5 例出现静脉回流障碍，2 例出现指尖挑拨口皮肤软组织部分坏死，均经对症处理后成活；其余断指再植后均顺利成活。23 例患儿均获随访，随访时间 3～14 个月，平均 9.4 个月。指尖外形佳、指腹饱满，指体无明显萎缩，指甲生长较平整，手指外形满意。再植手指远指间关节活动度无受限。 结论 动静脉转流术结合拔甲用于远端无静脉吻合条件的幼儿 Ishikawa Ⅱ区再植中，能提高再植成活率，临床疗效良好。