游离双股前外侧皮瓣修复全手脱套伤可行性研究
The feasibility study of free bilateral anterolateral femoral flaps to repair the whole hand degloving injury
目的 探索游离双侧股前外侧皮瓣瓦合修复全手脱套伤的可行性。 方法 （1）对50例健康、无手部残疾和疾病的成年人，分别测量手部掌、背侧皮肤纵长及横宽，记录测量数据及统计分析，计算修复全手脱套伤所需手供皮量；（2）在2具新鲜尸体标本上，建立左手全手脱套伤模型，将全手脱套伤的模型分成掌侧和背侧两部分分区修复。掌侧创面设计一侧股前外侧皮瓣修复，背侧创面则设计对侧股前外皮瓣修复，两块皮瓣瓦合后修复全手脱套伤创面。 结果 50例活体测量数据，掌侧皮肤纵长为(13.84±0.88)cm(12.51~15.03cm)，宽为(14.48±1.11)cm(12.85~16.66cm)，背侧皮肤纵长为(12.15±1.09)cm(10.77~13.77cm)，宽为(14.92±1.11)cm(14.92~17.33)cm，均较文献报道股前外侧皮瓣的最大可切取值小。结论 游离双侧股前外侧皮瓣完全可以覆盖手掌侧、背侧创面，设计两块皮瓣瓦合修复全手脱套伤术式具有可行性。
Objective To explore the study of free bilateral anterolateral femoral flaps in treating the whole hand degloving injury. Methods The study includes experiments of living body measurement and autopsy experiments. In the Living body measurement, 50 healthy adults without hand diseases were randomly selected. Skin of the hand were divided into two parts：the dorsal and palmar parts. The vertical and horizontal length of the palmar and dorsal parts of the skin was measured and recorded. The skin area was calculated from the above data according to the living body measurement. The autopsy experiments included model establishment and simulation operation. The models of degloving injuries of hands in two left hands of fresh cadaver specimens were established. We divided the wound and the degloved skin into two parts: the dorsal part and the palm part. The dorsal wounds of models of degloving injuries of hands were covered with the anterolateral femoral flap of the ipsilateral thigh and palm sides were covered by anterolateral femoral flap of the contralateral thigh. Results Among the measurement data of 50 healthy adults, the vertical length of the palmar part was (13.84±0.88)cm (12.51~15.03 cm), the width was (14.48±1.11) cm(12.85~16.66 cm). The vertical length of the dorsal part was (12.15±1.09) cm (10.77~13.77 cm) , and the width was (14.92±1.11) cm(14.92~17.33 cm). All data mentioned above were smaller than the maximal size of the flap reported in the literature. Conclusion Free bilateral anterolateral femoral flaps can respectively provide a large enough soft tisssue to cover the wound surface of dorsal and volar sides of the hand. The surgical approach of combined free bilateral anterolateral femoral flaps in treatment of degloving juries of the hand is feasible.
Hand injuries / Degloving injury / Anterolateral femoral flap / Reconstruction
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