目的

探讨采用个性化腹部带蒂薄皮瓣修复手部复杂创面的临床疗效。

方法

2015年1月至2023年12月，解放军联勤保障部队第九一〇医院烧伤整形科收治符合入选标准的手部严重损伤患者85例，其中男48例，女37例，年龄8～66（35.25±16.23）岁。根据手部创面位置、形状、面积及腹部供瓣区情况，设计个性化腹部带蒂薄皮瓣（共199个）修复创面。其中采用不同形状皮瓣修复74例，采用皮瓣穿洞成为改良双蒂皮瓣修复6例，采用分段结扎缩窄腹部延迟皮瓣蒂部法修复5例。术后观察皮瓣存活情况、断蒂时间及手术次数、供瓣区愈合情况；随访观察皮瓣外形和质地，末次随访观察皮瓣两点辨别觉、手外观和功能恢复及供受区瘢痕情况。

结果

术后199个皮瓣均存活。采用不同形状皮瓣修复患者皮瓣平均断蒂时间为术后13.8 d，手术次数均为2次，供瓣区直接缝合60例（81.08%），部分缝合联合植皮14例，均一期愈合；采用改良双蒂皮瓣修复患者皮瓣平均断蒂时间为术后15.5 d，手术次数2～4次，供瓣区直接缝合2例、植皮4例，均愈合良好；采用分段结扎缩窄腹部延迟皮瓣蒂部法修复患者皮瓣平均断蒂时间为术后17.0 d，手术次数3～4次，供瓣区均部分缝合，残余小创面植皮。随访6个月～6年，皮瓣外形良好，质地柔韧，5例皮瓣略臃肿，行修薄术。末次随访时皮瓣两点辨别觉为6～14 mm，手功能评定优良率达97.65%，供受区瘢痕较轻。

结论

个性化设计腹部带蒂薄皮瓣，包括形状多样、皮瓣穿洞成为改良双蒂、分段结扎缩窄蒂部行早期断蒂等方法，皮瓣存活率高，疗程短，手外观及功能恢复良好，供瓣区损伤小，是修复手部复杂创面的有效方法。

Objective

To investigate the clinical effects of personalized abdominal pedicled thin flaps in repairing complex wounds of the hand.

Methods

From January 2015 to December 2023， a total of 85 cases with complex hand wounds who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA， including 48 males and 37 females， aged from 8 to 66（35.25±16.23） years.A total of 199 personalized abdominal pedicled thin flaps were designed according to the conditions of the wounds and abdominal donor sites.Among the 85 cases， wounds were repaired with differently shaped flaps in 74 cases， with flap perforation to create modified bipedicled flaps in 6 cases， and with segmental ligation to narrow abdominal delayed flap pedicle in 5 cases.Flap survival， time for pedicle division， number of surgeries， donor site healing， flap appearance and texture， flap two-point discrimination， hand appearance and function， and scar condition at the donor and recipient sites were observed.

Results

After surgery， all 199 flaps survived successfully.For those repaired with differently shaped flaps， the average time for pedicle division was 13.8 days， the number of surgeries was two， direct suturing was performed in 60 cases （81.08%） and partial suturing combined with skin grafting in 14 cases for the donor sites， and all wounds healed primarily.For those repaired with flap perforation to create modified bipedicled flaps， the average time for pedicle division was 15.5 days，the number of surgeries was 2-4， direct suturing was performed in 2 cases and skin grafting were performed in 4 cases， with all wounds healing well.For those repaired with segmental ligation to narrow abdominal delayed flap pedicle， the average time for pedicle division was 17.0 days， the number of surgeries was 3 or 4， and partial suturing combined with small skin grafting were performed for the donor sites in the 5 cases.Follow-up of 6 months to 6 years indicated that the flaps exhibited good appearance and soft texture， except that 5 flaps were slightly swollen and underwent thinning.At the final follow-up， the two-point discrimination of the flaps was 6 to 14 mm， the excellent and good rate of hand function assessment was 97.65%， and the scars at the donor and recipient sites were mild.

Conclusion

Personalized abdominal pedicled thin flaps， including differently shaped flaps， flap perforation to create modified bipedicled flaps， and segmental ligation to narrow abdominal delayed flap pedicle， have high flap survival rate， short treatment course， good hand appearance and functional recovery， and minimal donor site damage， so it is an effective method for repairing complex hand wounds.