探讨改良腹部带蒂皮瓣在手部严重烧创伤创面修复中的应用效果。

选取2020年8月至2024年10月解放军联勤保障部队第九一〇医院烧伤整形科收治的符合入选标准的手部严重烧创伤患者43例，根据不同创面修复方法分为观察组（22例）和对照组（21例）。观察组采用改良腹部带蒂皮瓣修复手部创面，包括设计个性化薄皮瓣、蒂部及指缝处皮瓣预留丝线、术后分期分段结扎阻断皮瓣局部血供后提前断蒂并分指，供瓣区如不能缝合则采用辅助皮瓣或自体皮片修复，供受区予负压封闭引流（VSD）敷料覆盖；对照组采用传统腹部带蒂皮瓣修复，剪去皮瓣远端部分大的脂肪颗粒，转移覆盖创面，术后3周断蒂，后期再行分指及皮瓣修整术，供瓣区缝合或植皮，供受区无菌纱布包扎。比较2组皮瓣断蒂时间、断蒂后7 d皮瓣成活率、手部创面愈合时间、手术次数及末次随访时皮瓣两点辨别觉、患者满意度和手部功能优良率。数据比较采用t检验、χ²检验、Fisher确切概率法及Mann-Whitney U检验。

观察组皮瓣断蒂时间早于对照组［（10.43±1.38）d 比（21.29±1.06）d，t=28.755，P<0.001］，断蒂后7 d皮瓣成活率高于对照组 ［100.0%（100.0%，100.0%）比 100.0%（96.5%，100.0%），Z=2.050，P=0.032］，创面愈合时间短于对照组［（16.71±1.45）d 比 （37.33±4.55）d，t=19.755，P<0.001］，手术次数少于对照组 ［2（2，2）次比3（2，3）次，Z=3.025，P=0.002］。末次随访时，观察组皮瓣两点辨别觉［（7.46±2.48） mm］与对照组［（8.33±2.56） mm］相比，差异无统计学意义（t=1.100，P=0.277）；观察组患者皮瓣外观满意度为90.9%，供瓣区外观满意度为86.4%，手功能优良率为95.5%，对照组分别为61.9%、57.1%、71.4%，2组比较差异均有统计学意义（χ²=5.064、4.560、4.551，P<0.05）。

与传统腹部带蒂皮瓣相比，采用改良腹部带蒂皮瓣修复手部严重烧创伤创面，皮瓣可以提前断蒂，并同时行分指术。断蒂后皮瓣成活率高，手部创面愈合时间短，手术次数少，皮瓣感觉不受影响，且患者对供受区外观更满意，手功能恢复更好。

To explore the clinical efficacy of modified abdominal pedicled flap in repairing severe burn and trauma wounds of the hand.

From August 2020 to October 2024， 43 patients with severe hand burn and trauma injuries admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA were divided into observation group （22 cases） and control group （21 cases） based on different wound repair methods. The observation group was treated with modified abdominal pedicled flaps， including the design of individualized thin flaps， reservation of silk threads in the pedicle and interdigital areas， and early pedicle division and finger separation after staged and segmented ligation to block local blood supply post-operation. If the donor site could not be sutured， auxiliary flaps or autografts were used for repair， and vacuum sealing drainage （VSD） dressings were applied to both donor and recipient sites. The control group was treated with traditional abdominal pedicled flaps， large fat particles at the distal end of the flap were removed, and the flap was transferd to cover the wound， pedicle division was performed at 3 weeks post-operation， followed by finger separation and flap revision at a later stage. Donor sites were sutured or grafted， and recipient and donor sites were dressed with sterile gauze. The pedicle division time， flap survival rate at 7 days after pedicle division， wound healing time and number of operations were compared between the two groups. At the last follow-up, two-point discrimination， patient satisfaction， and the excellent and good rate of hand function recovery were compared between the two groups. Data were analyzed using t-test， χ² test， Fisher's exact test， and Mann-Whitney U test.

The flap pedicle division time of the observation group was earlier than that of the control group ［（10.43±1.38） d vs. （21.29±1.06） d， t=28.755， P<0.001］. The flap survival rate at 7 days after pedicle division in the observation group was higher than that in the control group ［100.0% （100.0%， 100.0%） vs. 100.0% （96.5%， 100.0%）， Z=2.050， P=0.032］. Compared to the control group, the wound healing time was shorter ［（16.71±1.45） d vs. （37.33±4.55） d， t=19.755， P<0.001］， and the number of operations was fewer ［2 （2， 2） vs. 3 （2， 3）， Z=3.025， P=0.002］ in the observation group. At the last follow up， the two-point discrimination of the flap in the observation group showed no statistically significant difference compared to the control group ［（7.46±2.48） mm vs. （8.33±2.56） mm， t=1.100， P=0.277］. The satisfaction rate with flap appearance was 90.9%， the satisfaction rate with donor site appearance was 86.4%， and the excellent and good rate of hand function was 95.5% in the observation group， while those were 61.9%， 57.1%， and 71.4% in the control group， respectively. The differences between the two groups were statistically significant （χ²=5.064， 4.560， 4.551， P<0.05）.

Compared to the traditional abdominal pedicled flaps， the modified abdominal pedicled flaps for repairing severe hand burn and trauma wounds allows for earlier pedicle division and simultaneous finger separation. After division， the flap exhibits a higher survival rate， shorter wound healing time， fewer surgical procedures， unaffected flap sensation， and greater patient satisfaction with the appearance of both donor and recipient sites， along with better hand function recovery.