[1]唐陵,陈栋栋,金国栋,等.第一掌背筋膜皮瓣联合膜诱导技术在拇指复合组织缺损治疗中的应用[J].中国中医骨伤科杂志,2023,31(07):56-60.[doi:10.20085/j.cnki.issn1005-0205.230711 ]
　TANG Ling,CHEN Dongdong,JIN Guodong,et al.Application of the First Dorsal Metacarpal Fasciocutaneous Flap Combined with Membrane Induction Technique on the Treatment of Thumb Complex Tissue Defects[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(07):56-60.[doi:10.20085/j.cnki.issn1005-0205.230711 ]
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第一掌背筋膜皮瓣联合膜诱导技术在拇指复合组织缺损治疗中的应用()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年07期
页码:
56-60
栏目:
临床报道
出版日期:
2023-07-15

文章信息/Info

Title:
Application of the First Dorsal Metacarpal Fasciocutaneous Flap Combined with Membrane Induction Technique on the Treatment of Thumb Complex Tissue Defects
文章编号:
1005-0205(2023)07-0056-05
作者:
唐陵1; 陈栋栋1; 金国栋1; 傅立云1; 曾永文1; 吴源芸1△
1东阳市红会医院手外科(浙江 东阳,322100)
Author(s):
TANG Ling1; CHEN Dongdong1; JIN Guodong1; FU Liyun1; ZENG Yongwen1; WU Yuanyun1△
1Hand Surgery Department,Dongyang Honghui Hospital,Dongyang 322100,Zhejiang China.
关键词:
拇指;  膜诱导技术;  筋膜皮瓣;  骨移植;  复合组织缺损
Keywords:
thumb;  membrane induction technique;  fascial flap;  bone grafting;  complex tissue defects
分类号:
R687
DOI:
10.20085/j.cnki.issn1005-0205.230711
文献标志码:
B
摘要:
目的:探讨第一掌背筋膜皮瓣联合膜诱导技术治疗拇指复合组织缺损的临床疗效。方法:采用回顾性观察研究方法,自2017年1月至2022年7月间,收治25例拇指指骨、皮肤软组织缺损伴或不伴血运障碍的病例,采用第一掌背筋膜皮瓣联合膜诱导技术治疗。该技术分两个阶段:第一阶段,彻底清创,将骨水泥代替缺损骨并进行固定,根据血管、肌腱情况行相应的修复,缺损的皮肤软组织采用第一掌背筋膜皮瓣覆盖,供皮瓣区视情况直接缝合或游离皮片植皮。第二阶段,打开诱导膜,取出骨水泥,取自体髂骨植骨固定。术后随访观察伤口愈合、皮瓣质地、外形情况,根据影像学数据得到骨愈合时间、骨吸收及骨感染率等数据。使用密歇根手功能评分量表(MHQ)全面评估术后患者对患手功能及外观的满意度。结果:第一阶段术后2例皮瓣局部坏死,2例局部伤口延迟愈合,骨水泥外露,均在第二阶段手术时进行了处理。第二阶段术后1例伤口延迟愈合,1例取髂骨区出现脂肪液化,均经换药后愈合。25例均得到6～24个月的随访,平均时间为15个月,皮瓣弹性、质地均良好,外形饱满; 平均3.5个月出现坚固骨愈合,无骨感染情况,其中2例末节移植骨出现局部骨吸收。密歇根手功能评分量表评分结果:优15例,良10例,患者均对术后外观及功能满意。结论:第一掌背筋膜皮瓣联合膜诱导技术治疗拇指复合组织缺损疗效确切,是治疗拇指复合组织缺损的方法之一。
Abstract:
Objective:To investigate the clinical efficacy of the first dorsal metacarpal fasciocutaneous flap combined with membrane induction technique on the treatment of thumb complex tissue defects.Methods:A retrospective observational study was conducted.From January 2017 to July 2022,25 cases of thumb phalanx,skin and soft tissue defects with or without blood supply disorders were treated with the first dorsal metacarpal fasciocutaneous flap combined with membrane induction technique.The technique was divided into two stages.In the first stage,thorough debridement was performed,bone cement was used to replace the defect bone and fixed,and the corresponding repair was performed according to the blood vessels and tendons.The defect skin and soft tissue were covered by the first dorsal metacarpal fasciocutaneous flap,and the donor flap area was directly sutured or free skin grafting according to the situation.In the second stage,the induction membrane was opened,the bone cement was removed,and the autologous iliac bone graft was taken for fixation.The wound healing,flap texture,and shape were observed after operation.The data of bone healing time,bone resorption,and bone infection were obtained according to imaging data.The Michigan Hand Function Questionnaire was used to comprehensively evaluate the patient's satisfaction with the function and appearance of the affected hand after surgery.Results:After the first stage operation,2 cases of local flap necrosis and 2 cases of local wound delayed healing with bone cement exposure were treated during the second stage operation.After the second stage operation,delayed wound healing occurred in 1 case and fat liquefaction occurred at the iliac bone harvesting site in 1 case,and all healed after dressing change.All the 25 cases were followed up from 6 to 24 months,with an average time of 15 months.The skin flaps had good elasticity,texture and full shape.The average time of bony union was 3.5 months.There was no bone infection,and 2 cases of bone resorption at the end of the graft.The results of Michigan hand function questionnaire(MHQ)were excellent in 15 cases and good in 10 cases.All patients were satisfied with the appearance and function after operation.Conclusion:The first dorsal metacarpal fasciocutaneous flap combined with membrane induction technique has obvious efficacy on the treatment of complex tissue defects of the thumb,which is one of the methods for the treatment of complex tissue defects of the thumb.

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备注/Memo

备注/Memo:
基金项目:东阳市科学技术研究计划公益类项目(19-328)
东阳市科学技术研究计划公益类项目(20-312)
△通信作者 E-mail:645074120@qq.com
更新日期/Last Update: 2023-07-10