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TRANSPLANTATION OF ARTERIOLIZED VENOUS NETWORK FLAP WITH SENSORY NERVE FOR REPAIRING DEGLOVING INJURY OF FINGERS

Repairing degloving injury of fingers by transplantation of ateriolized venous network flap with sensory nerve for six cases (7 fingers). The flaps were all gotsurvived. The procedure of the operation was performed as following: 3～5 supperficial veins and the medial or lateral cutaneous nerve were separated on the palmar side of the forearm as pedicle. According to the defect, the corresponding flaps was designed and was transferred to the injuried finger. Anastomosed the veins with the two digital arteries and veins. Anastomosed the cutaneous nerve with the digital nerves. The patients were followed up for two years. The flaps were soft and wearresisting. The joint movements of the fingers were normal. The twopoints discrimination was 5 to 10mm. The contour of the fingers was satisfactory. The procedure has the following advantages: 1. carried out one operation; 2. good sensation, 3. good appearance and satisfactory function. The indications and factors affecting the survival of the flap were discussed.

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。

双侧股前外侧皮瓣瓦合修复全足皮肤脱套伤

植皮联合分裂式骨牵引矫治脱套伤后手掌横向挛缩一例

MICROSURGICAL REPAIR OF SKIN-DEGLOVING INJURY OF WHOLE HAND OR FOOT

OBJECTIVE: To investigate the clinical effects of the microsurgical treatment for the skin-degloving injury of the whole hand or foot. METHODS: From March 1984 to October 2001, we treated 6 cases of skin-degloving injury of the whole hand and foot. In 2 cases of skin-degloving hands, one was treated with free great omentum transplantation plus skin graft, the other with pedical abdominal S-shaped skin flap as well as mid-thick skin graft. In 4 cases of skin-degloving injury of the foot, 2 cases was repaired with free latissimus dosi musculocutaneous flap, 1 case with distall-based lateral skin flap of the leg and 1 case with free tensor fasciae latae muscle flap. The flap size ranged from 7 cm x 9 cm to 22 cm x 15 cm. One case was operated on the emergency stage, the other 5 cases on the delayed stage. The delayed time ranged from 2 to 14 days with an average of 6.6 days. RESULTS: All the flaps survived. After 1-2 year follow-up, the appearance and function of the hand and the foot were good. CONCLUSION: Microsurgery technique in repairing skin-degloving injury of the whole hand and foot can achieve good results. The keys to success are thorough debridement of the recipient area, appropriate selection of the donor site, good vascular anastomosis and active postoperative rehabilitation.

REPAIR OF MULTIPLE FINGERS DEGLOVING INJURY WITH ABDOMINAL“S”-TYPE SKIN FLAP

OBJECTIVE: To explore a new surgical management of multiple fingers degloving injury. METHODS: In 1994 to 1997, 47 cases with multiple fingers degloving injury were sutured by two reverse "s"-type skin flaps on abdominal flank. RESULTS: The skin flaps in 46 cases survived and the wounds obtained primary heal. CONCLUSION: The application of abdominal flank "s"-type skin flap is reliable and convenient in the treatment of multiple fingers degloving injury.

UDGEMENT OF SKIN VIABILITY IN DEGLOVING INJURIES BY SPLIT THICKNESS SKIN EXCISION

In extensive frictionavulsion injuries, part of the injuried skin was still viable, so that total excision of the avulsed skin should be avoided. After debridememt, sutured the avulsed skin flap in situ temporarily and took a split-thickness graft from it. If bleeding occurred from the splitted surface of the dermis which was meant that part of the skin was alive. Along the border between the bleeding and nonbleeding area, the nonbleeding area of skin was excised. This could preserve the viable skin to the maximal extent. From July 1991 to May 1992, the viability of the skin in 8 avulsion injuries was judged. The maximal avul sed area was 13% and the minimal was 6% of the total body surface. After the treatment, 90% of the avulsed skin was alive. The appearance was satisfactory.

ABDOMINAL BIPEDICLED SUBEPIDERMAL VASCULAR NETWORK FLAP IN REPAIR OF DEGLOVING INJURY OF HAND

OBJECTIVE: To evaluate the clinical result of repairing degloving injury of hand with abdominal bipedicled subdermal vascular-network flap in emergence. METHODS: From 1994 to 1997, 19 cases with degloving injury of hand were treated with two flaps, one flaps with the inferior epigastric artery as pedicle, another with superficial epigastric artery. The two skin flaps were designed oppositely to cover the injured hands. RESULTS: All the flaps survived. Followed up for 1 to 3 years, the contour of hands were fine. Extension of fingers was normal and opponers of thumbs was good. Range of flexion of metacarpo-phalangeal joints was from 45 to 60 degrees, and the proximal interphalangeal joints was from 10 to 25 degrees. CONCLUSION: For the subdermal vascular network, the bipedicled flaps of abdomen in repair of degloving injury of hand have sufficient blood supply, b resistance to infection, high survival rate, and good contour.

Multidisciplinary Collaboration for the Treatment of One Patients with Lower Extremity Degloving Injury

ObjectiveTo investigate multidisciplinary collaborative role in the treatment of patients with lower extremity degloving injury. MethodsThe wound therapy group and the Department of Orthopedics, Nutrition, and Psychology, and the Pain Clinic and Rehabilitation team collaboratively carried out the comprehensive intervention for a patient with lower extremity degloving injury in March 2013 in our hospital. The wound therapist was responsible for correct evaluation, debridement, infection control, maintaining moisture balance, and protecting wound edges of the skin; The wound team members were responsible for the entire treatment and healing process in the form of text and photos; Department of Orthopedics was responsible for secondary skin graft; Nutrition division was responsible for the correction of anemia in patients with hypoalbuminemia; Psychological service was responsible for psychological counseling as treatment accident sometimes brought psychological trauma; Pain outpatient service was responsible for consultation, formulating specific plans to control and relieve the patient's pain, and promote the patient's physical and mental rehabilitation process; Rehabilitation division was responsible for the guidance of patients on lower limb function exercise, prevention of knee joint rigidity, muscle stiffness, to promote the functional recovery of lower limbs. ResultsThe patient's wound was healed completely without scar or joint contracture. Function of lower limbs recovered to normal. Patients was very satisfied to the treatment, and had a total full recovery of body and mind, and returned to the family and society. ConclusionMultidisciplinary collaboration treatment for patients with lower extremity degloving injury can ease pain, eliminate psychological barriers, promote wound healing, and maintain the limb function.

双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤

目的总结双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤疗效。 方法2013年6月－2014年12月，采用双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤11例。男8例，女3例；年龄23～ 47岁，平均30岁。致伤原因：绞伤4例，压榨伤7例。损伤指别：示指4例，中指5例，环指2例。皮肤软组织脱套平面均在远指间关节以远。皮肤缺损范围3.0 cm×3.0 cm～5.0 cm×3.5 cm。受伤至手术时间4～12 h，平均7 h。皮瓣切取范围为1.5 cm×1.5 cm ～?2.5 cm×1.5 cm。供区游离植皮修复。 结果术后皮瓣及植皮均成活，创面Ⅰ期愈合。患者均获随访，随访时间6～10个月，平均7个月。皮瓣质地柔软、色泽满意，指端饱满、不臃肿。术后2周皮瓣两点辨别觉为5～10 mm，平均7 mm。术后6个月根据中华医学会手外科学会上肢部分功能评定试用标准，获优9例，良2例，优良率100%。 结论采用双侧指动脉神经束残端蒂皮瓣瓦合修复手指末节脱套伤具有操作简便、手术创伤小等优点，术后手部外观及功能恢复满意。