【摘要】　目的　 探討大面積手部皮膚脫套傷并缺損的修復(fù)方式。　方法　 2005年6月－2010年1月，應(yīng)用腹部皮瓣包埋和游離中厚皮片植皮結(jié)合負(fù)壓封閉引流（vacuum sealing drainage，VSD）技術(shù)治療手部大面積皮膚脫套傷合并缺損12例，其中男8例，女4例；年齡21~56歲，平均34歲。機(jī)器絞傷9例，車禍傷3例。所有損傷均合并肌腱、關(guān)節(jié)或骨質(zhì)外露；軟組織缺損范圍為9 cm×8 cm~25 cm×18 cm。受傷至手術(shù)時(shí)間4~17 h，平均6.5 h。手掌及手指缺損部位采用腹部帶蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游離中厚皮片植皮，再于植皮表面覆蓋VSD敷料，接負(fù)壓行持續(xù)吸引；所有患者均二期斷蒂并進(jìn)行分指或皮瓣成形手術(shù)。　結(jié)果　 術(shù)后2例手指部分皮瓣或植皮壞死，2例小部分皮瓣及植皮邊緣壞死，經(jīng)單純換藥后逐漸愈合，1例缺損較大、較深，先行換藥，待創(chuàng)面肉芽新鮮后行二期植皮手術(shù)，愈合良好 。其余皮瓣及植皮均成活，創(chuàng)面Ⅰ期愈合；供區(qū)植皮均成活，切口均Ⅰ期愈合。12例均獲6~42個(gè)月隨訪，2例手指末節(jié)軟組織缺損嚴(yán)重、血運(yùn)差，術(shù)后7~10 d末節(jié)壞死后短縮；3例掌側(cè)皮瓣移植后較臃腫；其余外觀均較滿意。所有患者創(chuàng)面愈合后1個(gè)月內(nèi)深、淺感覺功能均稍差，3~6個(gè)月逐漸恢復(fù)，但手指精細(xì)感覺恢復(fù)差，兩點(diǎn)辨別覺為6~13 mm，平均9.5 mm。所有患手平均掌指關(guān)節(jié)主動(dòng)活動(dòng)50°，指間關(guān)節(jié)20°。　結(jié)論　 腹部皮瓣包埋和游離中厚皮片植皮結(jié)合VSD技術(shù)能較好地修復(fù)手部大面積皮膚脫套傷并缺損，是一種實(shí)用、安全且簡便的手術(shù)方法。
【Abstract】　Objective　 To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects.　Methods　 From June 2005 to January 2010, 12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique. The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years. The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases. All the injuries combined with exposure of tendon, joint or bone. The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm. The time between injury and operation was 4 to 17 hours averaging at 6.5 hours. The palm of hand and fingers were repaired by abdominal pedicle skin flaps, and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage. About 3 weeks later, all pedicles of the abdominal flaps were cut off and flaps plasty were carried out.　Results　 All patients were followed up from 6 to 42 months with an average period of 17 months. All of the flaps and skin grafts survived. Only 6 patients had distal edge partial necrosis, and all of them healed after a short time of dressing changes or second-stage skin grafting. All skin grafts of the donor sites survived and all the wounds healed by first intention. All the injured hands recovered well to their original shape and function except partial bad skin sensation. The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm. The active motion of metacarpophalangeal joints averaged at 60°, and the interphalangeal articulations averaged at 30°.　Conclusion　 Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects, and it is practical, safe and simple.

引用本文： 吳風(fēng)富,程昌志,何少康,林舟丹. 腹部皮瓣和植皮聯(lián)合負(fù)壓封閉引流修復(fù)手部大面積皮膚脫套傷及缺損. 華西醫(yī)學(xué), 2011, 26(8): 1162-1164. doi: 復(fù)制

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