Objective: To investigate the effectiveness of combined tissue transplantation for repair of serially damaged injuries on radial side of hand and function reconstruction.
Methods: Between May 2013 and May 2017, 34 cases of serially damaged injuries on radial side of hand were treated. There were 29 males and 5 females; aged 17-54 years, with an average of 32.1 years. There were 23 cases of crushing injuries, 5 cases of bruising injuries, 4 cases of machine strangulation injuries, and 2 cases of explosion injuries. The time from injury to admission was 40 minutes to 3 days, with an average of 10 hours. According to the self-determined serially damaged injuries classification standard, there were 1 case of typeⅠa, 2 cases of typeⅠb, 10 cases of typeⅡa, 5 cases of type Ⅱb, 3 cases of type Ⅱc, 1 case of type Ⅱd, 7 cases of type Ⅲa, 3 cases of type Ⅲb, 1 case of type Ⅲc, and 1 case of type Ⅲd. According to the classification results, the discarded finger, nail flap, the second toe, anterolateral thigh flap, ilium flap, fibula flap, and other tissue flaps were selected to repair hand wounds and reconstruct thumb, metacarpal bones, and fingers.
Results: After operation, 2 cases of flaps developed vascular crisis and survived after symptomatic treatment; the other transplanted tissue survived smoothly. All cases were followed up 1 to 7 years, with an average of 2.4 years. The average fracture healing time was 7.4 weeks (range, 5.3-9.0 weeks). At last follow-up, the reconstructed fingers and the grafted flaps recovered good sensory function, with a two-point discrimination of 5 to 11 mm (mean, 9 mm). According to the evaluation standard of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the reconstructed thumb was rated as excellent in 24 thumbs, good in 8 thumbs, and fair in 2 thumbs; the reconstructed finger was rated as excellent in 18 fingers, good in 2 fingers, and fair in 1 finger.
Conclusion: For the serially damaged injuries on radial side of hand, according to its classification, different tissues are selected for combined transplantation repair and functional reconstruction, which can restore hand function to the greatest extent and improve the quality of life of patients.
目的: 探讨组织联合移植修复手部桡侧系列毁损伤的临床疗效。.
方法: 2013 年 5 月—2017 年 5 月，收治手部桡侧系列毁损伤 34 例。男 29 例，女 5 例；年龄 17～54 岁，平均 32.1 岁。致伤原因：碾压伤 23 例，重物砸伤 5 例，机器绞伤 4 例，爆炸伤 2 例。受伤至入院时间 40 min～3 d，平均 10 h。参照自定桡侧系列毁损伤分型标准：Ⅰa 型 1 例、Ⅰb 型 2 例，Ⅱa 型 10 例、Ⅱb 型 5 例、Ⅱc 型 3 例、Ⅱd 型 1 例，Ⅲa 型 7 例、Ⅲb 型 3 例、Ⅲc 型 1 例、Ⅲd 型 1 例。根据分型结果，选择废弃手指、踇甲瓣、第 2 足趾、股前外侧皮瓣、髂骨皮瓣、腓骨皮瓣等组织瓣进行联合移植修复手部创面以及重建拇指、部分掌骨及手指。.
结果: 术后除 2 例皮瓣出现血管危象，经对症处理后成活外，其余移植组织均顺利成活。34 例均获随访，随访时间 1～7 年，平均 2.4 年。骨折愈合时间 5.3～9.0 周，平均 7.4 周。末次随访时，再造手指及移植皮瓣均恢复较好感觉功能，两点辨别觉 5～11 mm，平均 9 mm。按中华医学会手外科学会上肢部分功能评定试用标准评定：再造拇指获优 24 指，良 8 指，可 2 指；再造手指获优 18 指，良 2 指，可 1 指。.
结论: 对于手部桡侧系列毁损伤，根据其分型选择不同组织联合移植修复与功能重建，能最大程度恢复手功能，提高患者生活质量。.
Keywords: Hand; combined transplantation; damaged injury; functional reconstruction; tissue flap; wound repair.