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find Keyword "脱套伤" 35 results
  • 指动脉串联逆行岛状皮瓣修复老年指端脱套伤

    目的总结指动脉串联逆行岛状皮瓣修复老年指端脱套伤的疗效。 方法2011年6月-2012年8月,收治7例老年指端脱套伤。男5例,女2例;年龄56~68岁,平均62岁。致伤原因:冲压伤4例,机器绞伤3例。损伤指别:示指3例,中指3例,环指1例。合并末节指骨骨折2例,伸肌腱止点撕脱1例,相邻指损伤1例。伤后至手术时间为3~5 d,平均3.6 d。术中在患指切取近节指根部及掌远端2块皮瓣瓦合修复指端皮肤软组织缺损;近节指根部侧方皮瓣切取范围为1.4 cm × 1.2 cm~2.0 cm × 1.8 cm,掌远端皮瓣为1.1 cm × 1.0 cm~1.8 cm × 1.5 cm。掌远端供区直接缝合,指根部供区游离植皮修复。 结果1例掌远端皮瓣术后12 h发生静脉危象,经间断拆线后缓解;其余皮瓣及供区植皮均顺利成活,创面Ⅰ期愈合。术后7例均获随访,随访时间6~20个月,平均12个月。皮瓣外形、质地均良好。末次随访时,近节指根部侧方皮瓣两点辨别觉为7~10 mm,掌远端皮瓣为8~12 mm;手指功能参照中华医学会手外科学会上肢部分功能评定试用标准:获优6例,良1例。 结论指动脉串联逆行岛状皮瓣是利用远侧指间关节指固有动脉交通支的解剖特点,将相邻的2块皮瓣瓦合修复老年患者指端脱套伤,手术操作简便,疗效满意。

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • REPAIR OF DEGLOVING INJURY OF FINGERTIP WITH VASCULAR PEDICLED CROSS FINGER FLAP

    Objective To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. Methods Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years (range, 17-46 years). The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm (mean, 1.8 cm). Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes (mean, 150 minutes). The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm × 2.3 cm to 4.2 cm × 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months (mean, 7 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm (mean, 8.1 mm). The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. Conclusion The treatment of degloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appearance.

    Release date:2016-08-31 10:53 Export PDF Favorites Scan
  • CLASSIFICATION AND TREATMENT OF WHOLE HAND DEGLOVING INJURY

    Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • REPAIRING DEGLOVING INJURY OF DISTAL PHALANX WITH HOMODIGITAL BILOBED FLAPS TILED

    Objective To study the methods and effectiveness of repairing degloving injury of the distal phalanx with homodigital bilobed flaps tiled. Methods Between April 2008 and June 2011, 40 patients (40 fingers) with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years(mean, 30 years). The time from injury to operation was 1-5 hours (mean, 2.5 hours). Affected fingers included index in 13cases, middle finger in 11 cases, ring finger in 9 cases, and l ittle finger in 7 cases. The defect area ranged from 3.0 cm × 2.0 cm to 5.5 cm × 3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arteril ization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm × 1.5 cm to 2.6 cm × 2.2 cm and the area of the next leaf flaps ranged from 2.5 cm × 2.0 cm to 3.5 cm × 2.5 cm. The donor sites were covered with free flaps. Results Flap bl ister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975, the results were excellent in 27 cases, good in 2 cases, and fair in 1 case, and the excellent and goodrate was 96.7%. Conclusion The homodigital bilobed flaps tiled for degloving injury of the distal phalanx is simple and easyto- operate with less injury.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 脱套皮肤冷藏延期回植法治疗全足脱套伤

    目的 评价脱套皮肤修薄冷藏、延期回植法治疗全足脱套伤疗效。 方法 2007 年3 月- 2010 年9 月,收治全足脱套伤7 例。男5 例,女2 例;年龄20 ~ 55 岁,平均35 岁。致伤原因:机器挤压撕脱伤4 例,车轮碾压撕脱伤2 例,重物砸伤1 例。均从踝关节平面以远皮肤脱套,其中4 例趾根部分皮肤未完全脱套。一期行足清创、持续封闭式负压引流治疗,脱套皮肤修薄冷藏;待引流量lt; 10 mL/d 行二期皮肤回植。 结果 术后7 例皮肤成活50% ~ 95%;根据贾金鹏等的皮肤成活评价标准,优4 例,良2 例,中1 例。其中4 例经去痂换药后创面愈合,3 例行切痂植皮术后愈合。患者均获随访,随访时间7 ~ 24 个月,平均15 个月。术后1 年1 例发生足底溃疡不愈;其余患者足部外形均满意,足底感觉恢复至 S3 ~ S3+,足背为S2 ~ S3,行走功能正常。 结论 脱套皮肤冷藏延期回植法操作简便,回植皮肤成活率较高,是治疗全足皮肤脱套伤的一种较好方法。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • REPAIR OF COMPLICATED DEGLOVING INJURIES OF OPPOSITE FINGER WITH AKIN UNITED FLAPS PEDICLED WITH DORSAL CARPAL BRANCH OF ULNAR ARTERY

    Objective To evaluate the cl inical efficacy of akin united flaps pedicled with dorsal carpal branch of ulnar artery in repairing compl icated degloving injuries of the opposite fingers. Methods Between August 2005 and August 2009, 11 cases of compl icated degloving injuries of single finger were treated, including 8 males and 3 females with an average age of 26 years (range, 19-55 years). The defect locations were thumb in 1 case, index finger in 7 cases, and middle finger in 3 cases, including 9 cases of mechanical injury and 2 cases of traffic accident injury. The extent of skin avulsion was the proximal segments or beyond the middle segment of finger with a defect range from 5.0 cm × 4.5 cm to 8.0 cm × 5.5 cm. Compl icated injuries included phalangeal fracture in 2 cases, extensor tendon injury in 3 cases, flexor and extensor tendon injuries in 1 case, digital vascular injury in 9 cases, and digital nerve injury in 6 cases. The time from injury to operation was 2-18 hours (mean, 4.8 hours). The akin united flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery. The proximally pedicled flaps enclosed palmar finger, and the distally pedicled flaps enclosed dorsal finger. The size of flaps ranged from 10 cm × 3 cm to 16 cm × 3 cm. The donor sites were sutured directly. After 3 weeks, the pedicle was cut. Results Light yellow secretion and eczema on the flap were observed in 1 case at 3 days, were cured after 2 weeks of dressing change; other flaps survived and healing of incisions by first intention was achieved. The incisions at donor sites healed by first intention. The secondary plastic operation was performed in 2 cases because of bulky flaps at 3 months after operation. Eleven patients were followed up postoperatively 6-12 months (8 months on average). The texture and appearance of all the flaps were satisfactory. The two-point discrimination was 12-20 mm with satisfactory recovery of finger function at 6 months after operation. According to Jebsen standard, the results were excellent in 8 cases, good in 2 cases, and poor in 1 case. Conclusion With rel iable blood supply, easy dissection, less injury at donor site, and good repair results, the akin united flaps pedicled with dorsal carpal branch ofulnar artery is a good method to repair complicated degloving injuries of the opposite fingers.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 皮肤回植联合封闭式负压引流技术治疗四肢皮肤脱套伤

    目的 总结封闭式负压引流技术(vaccum sealing drainage,VSD)联合一期皮肤回植治疗四肢皮肤脱套伤的临床效果。 方法 2009 年3 月- 2010 年3 月,采用VSD 联合一期皮肤回植修复25 例四肢皮肤脱套伤患者。男16 例,女9 例;年龄9 ~ 53 岁,中位年龄32 岁。致伤原因:交通事故伤19 例,高处坠落伤3 例,重物砸伤3 例。部位:手背3 例,前臂6 例,小腿10 例,足踝及足背 6 例。脱套范围为14 cm × 9 cm ~ 42 cm × 23 cm。合并骨折8 例,血管、神经损伤2 例。受伤至入院时间4 ~ 8 h。 结果  22 例经7 ~ 10 d VSD 治疗后,回植皮肤顺利成活;3 例经VSD 治疗10 d 后仍有点状坏死,经换药后愈合。25 例均获随访,随访时间3 ~ 12 个月,平均9 个月。全厚皮片回植后颜色接近正常皮肤,弹性良好,质地柔软,小腿两点辨别觉2 ~ 3 cm;中厚皮回植后部分颜色发暗,质地较硬,小腿两点辨别觉6 ~ 8 cm。8 例合并骨折者骨折愈合时间3 ~ 8 个月,平均5 个月;1 例尺神经断裂者6 个月后骨间肌萎缩,另1 例血运、感觉、运动均较好。 结 论 急诊VSD 在治疗四肢皮肤脱套伤中能充分引流、均匀加压、改善血循环、促进脱套皮肤成活。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • REVERSE ISLAND FLAP OF DIGITAL ARTERY PARALLEL FOR REPAIRING DEGLOVED INJURIES OF FINGERTIP

    Objective To investigate the effectiveness of reverse island flaps of digital artery parallel for repairing degloved injuries of the fingerti p. Methods Between June 2008 and January 2010, 13 cases of degloved injuries of the fingertip were treated. There were 8 males and 5 females with an average age of 34 years (range, 19-62 years). The causes of injuries were as follow: impact and press injury in 5 cases, wringer injury in 7 cases, and crush injury in 1 case. The injured fingers were comprised of index finger in 6 cases, middle finger in 4 cases, ring finger in 2 cases, and l ittle finger in 1 case. The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm to 3.0 cm × 2.5 cm. Three cases compl icated by fracture of thedistal phalanx, 1 case by rupture of the insertion of extensor tendon, and 1 case by rupture of the insertion of flexor tendon. The average time from injure to surgery was 4 hours (range, 1 hour and 30 minutes-12 hours). Two neighboring skin flaps located in the same course of digital artery were adopted to repair defect of the fingertip. The size of proximal skin flap ranged from 1.2 cm × 1.0 cm to 2.0 cm × 1.5 cm and the size of distal skin flap ranged from 1.1 cm × 1.0 cm to 1.5 cm × 1.3 cm. The free skin grafts were used to repair the donor sites. Results Circulation crisis occurred in 1 case at 2 hours after operation and was el iminated by interval disconnecting. The other flaps and skin grafts survived and the wounds healed by first intention. The patients were followed up 6-18 months (mean, 10 months). All flaps presented the satisfactory appearance and texture, and the flexion and extension function of wounded fingers recovered to normal. Two-point discrimination ranged from 7 to 11 mm at last follow-up. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion Based on the anatomical features of communicating branches of distal interphalangeal joint, two neighboring flaps located in the same course of digital artery are adopted to repair soft tissue defect of the fingertip. This surgical method is a simple and effective method.

    Release date:2016-08-31 05:45 Export PDF Favorites Scan
  • 吻合静脉加负压引流治疗全手掌皮肤脱套伤

    目的 总结吻合静脉加负压引流治疗全手掌皮肤脱套伤的治疗方法和临床效果。 方法 2005 年6 月- 2007 年9 月,收治全手掌皮肤脱套伤7 例。男5 例,女2 例;年龄17 ~ 45 岁,平均30 岁。机器压伤5 例,滚轴绞伤2 例。手掌、手背自腕横纹逆行脱套至指蹼。受伤至手术时间为1 ~ 6 h,平均3 h。术中吻合皮下静脉、重建静脉回路,伤口内放置负压引流进行原位修复。 结果 6 例脱套皮肤全部成活;1 例脱套皮肤远端掌侧部分坏死,行游离植皮后成活。7 例均获随访,随访时间3 ~ 17 个月,平均12 个月。手部外形及色泽基本正常,出汗正常,手指屈、伸及感觉功能恢复良好。按中华医学会手外科学会上肢部分功能评定试用标准:获优3 例,良3 例,差1 例,优良率85.7%。 结论 吻合静脉加负压引流可以减轻皮肤水肿,提高脱套皮肤的成活率,是治疗全手掌皮肤脱套伤的一种较好方法。

    Release date:2016-08-31 05:48 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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