医用无菌手套辅助下裁剪布样在手指脱套缺损修复中的应用

医用无菌手套辅助下裁剪布样在手指脱套缺损修复中的应用

侯桥陆金琴葛梅庄伟洪锋瞿钢全仁夫刘玲芬富红梅

本文来源：《中华整形外科杂志》2023年8月第39卷第8期

DOI:10. 3760 / cma.j.cn114453-20220725-00232

作者单位：浙江中医药大学滨江学院附属江南医院手外科2病区，杭州311200

通信作者：侯桥，Email：lanse0603@163.com

引用本文

侯桥,陆金琴,葛梅,等. 医用无菌手套辅助下裁剪布样在手指脱套缺损修复中的应用[J]. 中华整形外科杂志,2023,39(08)：873-878.DOI:10.3760/cma.j.cn114453-20220725-00232

【摘要】

目的探讨医用无菌手套辅助下裁剪布样在手指脱套缺损修复中的应用效果。

方法回顾性分析2015年4月至2021年12月于浙江中医药大学滨江学院附属江南医院治疗的手指皮肤软组织脱套性缺损患者的临床资料。术中采用医用无菌手套辅助制作指体缺损的布样，再按布样切取足背部皮瓣或（足母）甲皮瓣修复指体缺损。术后观察皮瓣成活情况及指体外观；调查患者对手部外观及功能的满意度；采用中华医学会手外科学会上肢部分功能评定试用标准评价手指功能。

结果共纳入12例患者(13指)，男9例(10指)，女3例(3指)；年龄17~54岁，平均37岁；左手5例(5指)，右手7例(8指)，均为单侧手指损伤。术中切取的足背部皮瓣及（足母）皮瓣恰到好处，面积为5.5 cm×4.5 cm~10.5 cm×5.8 cm。术后随访3~15个月，平均7个月，移植的足背部皮瓣及（足母）甲皮瓣全部成活，指体外观不臃肿，患者对手部外观及功能均非常满意；手指功能评价：优7例，良5例。

结论应用无菌手套辅助裁剪布样修复手指脱套损伤，可以简化手术操作，减少供区的损伤，做到缺多少补多少，使修复的手指获得较好的外形和功能。

【关键词】外科皮瓣；外科手套；解剖模型；指损伤；移植

Application of medical sterile gloves-assisted cutting cloth sample in repairing finger degloving injury

Hou Qiao, Lu Jinqin, Ge Mei, Zhuang Wei, Hong Feng, Qu Gang, Quan Renfu, Liu Lingfen, Fu Hongmei

Second Area of Hand Surgery Department, Jiangnan Hospital Affiliated with Binjiang College of Zhejiang University of Traditional Chinese Medicine, Hangzhou 311200, China

Corresponding author: Hou Qiao, Email: lanse0603@163.com

【Abstract】

Objective To investigate the application effect of medical sterile gloves-assisted cutting cloth samples in the repair of finger degloving injury.

Methods The clinical data of patients with finger skin and soft tissue degloving defects treated in Jiangnan Hospital Affiliated with Binjiang College of Zhejiang University of Traditional Chinese Medicine from April 2015 to December 2021 were analyzed retrospectively. Medical sterile gloves were used to make cloth samples of finger defects, and then the dorsal foot flap or toenail flap was cut according to the cloth samples to repair finger defects. The survival of flaps and the appearance of the fingers’ body were observed after surgery, and the patients’ satisfaction was investigated. The finger function was evaluated by the trial standard of upper limb function evaluation of the Hand Surgery Society of Chinese Medical Association.

Results A total of 12 patients with 13 fingers were enrolled. There were 9 males (10 fingers) and 3 females (3 fingers), aged 17-54, average of 37-year-old. There were 5 cases (5 fingers) in the left hand and 7 cases (8 fingers) in the right hand, all with unilateral finger injury. The size of the dorsal flaps and great toenail flaps harvested were appropriate, ranging from 5.5 cm×4.5 cm to 10.5 cm×5.8 cm. After surgery, all patients were regularly followed up for 3-15 months, an average of 7 months. All the dorsal flap and great toenail flap of the foot after surgery survived, and the appearance of the finger body was not bloated. All patients were very satisfied with the appearance and function of the hand, and the finger function was evaluated as excellent in 7 cases and good in 5 cases.

Conclusion The application of sterile gloves-assisted cutting cloth samples for the treatment of finger degloving injury can simplify the procedure, reduce donor damage, make up for the lack as much as needed, and the repaired fingers can obtain better shape and function.

【Key words】Surgical flaps; Surgical gloves; Anatomical model; Finger injury; Transplantation

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of Jiangnan Hospital Affiliated with Binjiang College of Zhejiang University of Traditional Chinese Medicine (202112).

手指脱套缺损是手部一种严重的创伤，处理起来较为棘手，由于手指为一个长圆柱体，受伤后创缘往往不规则，很难直接在脱套的手指上制作出形状合适的布样或切取厚薄适中、大小恰当的皮瓣进行修复，故皮瓣修复种类报道不多。临床上常采用截指术、腹部带蒂皮瓣修复术或游离足趾再造术等方式进行修复[ 1 , 2 , 3 ]，治疗效果欠佳。我们对手指脱套缺损采用医用无菌手套辅助下裁剪布样再切取足背部皮瓣或（足母）甲皮瓣进行修复，获得了满意的临床效果。

一、资料选择

回顾性分析2015年4月至2021年12月于浙江中医药大学滨江学院附属江南医院治疗的手指皮肤软组织脱套性缺损患者的临床资料。纳入标准：(1)年龄60岁以下，能耐受皮瓣移植手术；(2)手术方式为足背部皮瓣或（足母）甲皮瓣移植修复软组织缺损；(3)术中采用医用无菌手套辅助下裁剪布样设计切取皮瓣。排除术后随访脱落和病历资料不完整者。

本研究获浙江中医药大学滨江学院附属江南医院伦理委员会审核批准(202112)。患者和家属均签署知情同意书。

二、方法

(一)手术方法

患者取仰卧位，采用臂丛神经阻滞麻醉联合脊椎麻醉，上下肢均缚气囊止血带。先处理手部术区，彻底清除创缘及创面内坏死及污染的组织，找到受区血管、神经吻合口，如指总动脉、掌背部静脉和指神经断端，或鼻烟窝处的桡动脉及其伴行静脉、头静脉，并打开皮下隧道。松开止血带，予以创面止血。采用合适大小的医用无菌手套戴于脱套缺损的手指上，根据创缘标记指体缺损的设计线，然后将指套沿设计线剪下，在远离切取皮瓣轴心血管的一侧剪开并标记缝合的对应点。将剪开的指套在无张力下平铺于制作布样的无菌单或无纺布上，画出图形的边界并标记指套剪开时的对应点，然后修剪布样。根据布样在足部供区设计皮瓣的大小及形状，并按常规切取皮瓣。皮瓣切取后，转移至受区，将血管蒂捋顺并转移至吻合口处后，缝合皮瓣。先按照相应位置缝合与创缘的连接点，再按照标记将皮瓣缝合成皮管，最后吻合血管及神经。供区创面一期予以脱细胞人工真皮覆盖[ 4 , 5 ]，二期植皮修复。

(二)术后处理及随访

术后患肢予以石膏托固定保护，并予以皮瓣烤灯护理，常规给予抗感染、活血、扩容等对症治疗，术后7~10 d待血管危险期渡过后，去除外固定，指导患者下地活动，并进行手指功能锻炼，术后2周拆线。术后5~6周到康复科行功能锻炼。采用门诊、电话或微信随访，观察患者手指皮瓣外观；调查患者对手部外观及功能的满意度；采用中华医学会手外科学会上肢部分功能评定试用标准[ 6 ]评价再造手指功能，分为优、良、可、差。

三、结果

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