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find Author "费小轩" 4 results
  • MICROSURGERY FOR SEVERE FLEXION CONTRACTURE OF PROXIMAL INTERPHALANGEAL JOINT

    Objective To investigate the cl inical results of cross-finger flap combined with laterodigital pedicled skin flap for repair of severe flexion contracture of the proximal interphalangeal joint. Methods Between October 2008 and February 2011, 11 patients (11 fingers) with severe flexion contracture of the proximal interphalangeal joint were treated with cross-finger flap combined with laterodigital pedicled skin flap. There were 7 males and 4 females, aged 20-63 years (mean, 32.6years). The causes of injury were crush or electric-saw injury in 7 cases, burn or explosive injury in 3 cases, and electrical injury in 1 case. The locations were the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 2 cases, and the l ittle finger in 3 cases. The mean disease duration was 12.4 months (range, 6-24 months). All cases were rated as type III according to Stern classification standard. The volar tissue defect ranged from 3.0 cm × 1.5 cm to 5.0 cm × 2.5 cm, with exposed tendons, nerves, vessels, or bone after scar relaxation. The defects were repaired with cross-finger flaps (2.2 cm × 1.8 cm to 3.8 cm × 2.5 cm) combined with laterodigital pedicled skin flaps (1.5 cm × 1.2 cm to 2.5 cm × 2.0 cm). Double laterodigital pedicled skin flaps were used in 3 cases. The flap donor site was sutured directly or repaired with the skin graft. Results All flaps survived completely and wound healed by first intention. The donor skin graft survived. All the patients were followed up 6-18 months (mean, 11.3 months). The finger appearance was satisfactory. The flaps had soft texture and good color in all cases. No obvious pigmentation or contraction was observed. The contracted fingers could extend completely with good active flexion and extension motion. At last follow-up, the extension of the proximal interphalangeal joint was 10-15°. Based on proximal interphalangeal joint motion standard of Chinese Medical Association for hand surgery, the results were excellent in 6 cases, good in 4 cases, and fair in 1 case; the excellent and good rate was 90.9%. Conclusion It is an easy and simple therapy to cover wound area of severe flexioncontracture of the proximal interphalangeal joint after scar relaxation using cross-finger flap combined with laterodigital pedicled skin flap, which can repair large defect and achieve good results in finger appearance and function.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤

    目的 总结逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤的手术方法和临床效 果。 方法 2004 年 8 月- 2008 年12 月,收治 22 例23 指末节毁损型离断伤患者。男 16 例17 指,女 6 例 6 指;年龄12 ~ 67 岁,平均36 岁。撕脱伤11 例11 指,压砸伤9 例10 指,爆炸伤2 例2 指。示指9 指,中指7 指,环指5 指,小指2 指。缺损平面均在中节指骨以远,缺损长度1.1 ~ 2.3 cm。受伤至手术时间为30 min ~ 8 h。术中采用范围为4.6 cm ×0.6 cm ~ 6.1 cm × 2.2 cm 的逆行指动脉背侧支三叶皮瓣修复。供区植皮修复。 结果 术后3 例皮瓣出现静脉危象,经换药愈合;其余皮瓣及供区植皮均顺利成活,切口Ⅰ期愈合。16 例16 指获随访,随访时间6 ~ 25 个月,平均16.5 个月。皮瓣质地柔软,外观饱满,无臃肿,指端无触痛。皮瓣两点辨别觉为6 ~ 10 mm。术后6 个月手功能按总主动活动度法评定,优9 指,良6 指,可1 指,优良率93.8%。 结 论 逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤手术简便、安全,疗程短,是一种较为理想的方法。

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP

    ObjectiveTo investigate the effectiveness of free second toe dorsal flap combined with middle or ring finger island flap for repairing degloved thumbs. MethodsBetween August 2009 and June 2013, 6 patients with degloving injury of the thumb were treated using free second toe dorsal flap combined with middle or ring finger island flap. There were 4 males and 2 females, aged 19-44 years (mean, 32 years). The left thumb was involved in 2 cases and the right thumb in 4 cases, including 5 cases of type II and 1 case of type III degloving injury. The size of wound was 5.5 cm×2.5 cm to 6.5 cm×5.0 cm. After emergency debridemented, 5 patients underwent vacuum sealing drainage and surgical repair after 3-5 days; 1 patient underwent abdominal embedding and repair after 14 days. The size of second toe dorsal flap ranged from 2.5 cm×2.2 cm to 4.2 cm×3.0 cm, and the size of middle or ring finger island flap ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm. Neurorrhaphy was performed between the plantar digital nerve of the second toe and the proper digital nerve at the recipient site in 5 cases, and no nerve anastomose in 1 case. All the distal phalanxes were partially excised. The donor sites were covered with free skin grafts. ResultsAll of the flaps survived completely and incision healed by first intention. Three patients had alloesthesia of the middle or ring finger island flaps. All of the 6 patients were followed up from 6 months to 3 years (mean, 23 months). The flaps had good color and soft texture, and the finger had satisfactory appearance, but the fingernails were smaller than that of normal side. The sensation of the dorsum of the second toe reached S3, and the mean two-point discrimination of the pulp was 6 mm (range, 4-7 mm). According to total active movement (TAM) system, the function of the thumbs was excellent in 5 cases and good in 1 case. ConclusionA combination of free second toe dorsal flap and middle or ring finger island flap is a useful and reliable technique for reconstruction of a degloved thumb.

    Release date:2016-11-14 11:23 Export PDF Favorites Scan
  • 改良邻指皮瓣联合第二趾甲瓣修复手指中末节皮肤脱套伤

    目的 总结采用改良邻指皮瓣联合第2 趾甲瓣修复手指中末节脱套伤的方法及临床疗效。方 法 2005 年 9 月- 2009 年12 月,收治11 例11 指手指中末节皮肤脱套伤患者。男8 例,女3 例;年龄21 ~ 45 岁,平均28 岁。损伤原因:绞伤8 例,挤压伤3 例。损伤指别:示指5 例,中指5 例,环指1 例。皮肤撕脱平面:远指间关节 4 例,中节中部5 例,近指间关节2 例。创面范围6 cm × 3 cm ~ 7 cm × 4 cm。受伤至手术时间2 ~ 4 d,平均3 d。采用3.5 cm ×3.0 cm ~ 4.0 cm × 3.5 cm 的改良邻指皮瓣联合2.5 cm × 2.0 cm ~ 6.0 cm × 2.5 cm 的第2 趾甲瓣修复创面。改良的邻指皮瓣均带有指固有动脉背侧支,蒂宽1.0 ~ 1.5 cm。供区取中厚皮片植皮修复。 结果 术后皮瓣及植皮均顺利成活,供受区切口均Ⅰ期愈合。11 例均获随访,随访时间4 ~ 10 个月。趾甲生长良好,外形较满意。指腹感觉恢复,两点辨别觉为6 ~ 8 mm,平均6.5 mm。手指伸屈功能按手指总主动活动度(TAM)评分法评定,优8 指,良3 例。 结论 改良邻指皮瓣联合第2 趾甲瓣是修复手指中末节皮肤脱套伤的一种较好方法。

    Release date:2016-09-01 09:03 Export PDF Favorites Scan
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