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題 名 | Free Lateral Arm Fascial Flap Reconstruction for Multiple Digital Amputation Followed by Reshaping with Elastic Cohesive Bandage--Case Report and Review of the Literature=利用自由上臂外側筋膜皮瓣重建多指節遠端複合缺損--病例報告及文獻回顧 |
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作 者 | 許韶芸; 鄭旭棠; 許永昌; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 27:1 2018.03[民107.03] |
頁 次 | 頁45-51 |
分類號 | 416.413 |
關鍵詞 | 自由上臂外側筋膜皮瓣; 多指節遠端缺損; 手部重建; Free lateral arm fascial flap; Multiple distal digit defects; Hand reconstruction; |
語 文 | 英文(English) |
中文摘要 | 背景:多指節遠端的複合缺損常造成重要構造暴露,指端缺損需要特殊厚度的皮瓣,且輪廓須完全重建以免影響未來功能及美觀,因此,多指節的遠端重建是一個重要的議題。目的及目標:我們報告一個因創傷導致多指遠端截斷及“脫手套”損傷的病患病患,以自由上臂外側筋膜皮瓣,並使用自黏性彈性紗布壓迫塑型,達到正常手指輪廓,重建成功。此類病患其他可能的治療方式也會在文中探討。材料及方法:一位40歲有無特殊病史,因工作時機器壓砸傷造成慣用手多指遠端截肢及復合性缺損的的男性病患,造成三指韌帶,指骨暴露。我們以自由上臂外側筋膜皮瓣完成傷口初步重建及傷口覆蓋。第二階段再將皮瓣以自黏性彈性紗布塑型及補皮,只需要些微的整形手術,臨床結果即令人滿意。結果:經過三個月後,移植皮瓣血循良好,手指外觀及功能幾乎完全正常。病人可回復日常生活及原來工作,臨床結果成功。結論:在手部重建,多指節遠端的複合缺損的處理是相當困難的,特別是要完全恢復病人的外觀及功能。局部皮瓣常無法提供足夠的組織覆蓋,或血管長度不足;而身體其他部位之自由皮瓣多半都太過肥厚,血管長度和直徑差異也很大;自由上臂外側筋膜皮瓣對於此類案例可能是一個良好的重建方式,特別是使用自黏性彈性繃帶塑型,可達到比其他重建方式更優異的外觀及功能。 |
英文摘要 | Background: Reconstruction for multiple distal defects is very challenging. It highly requires accurate contouring of the flap to maintain satisfactory functional and aesthetic results to fulfill daily use. The small diameter of the recipient vessels in hand region also incurs difficulties when reconstructing the defects with free flaps. Many reconstruction options have been reported. However, there is no conclusion for optimal reconstruction. Aim and objectives: We report a case with multiple digit amputation. After resurfacing of the digital defects, an innovative reshaping methods with elastic cohesive bandage was used to achieve good contour. The case was successfully reconstructed with free lateral arm fascial flap, resulted in good functional and aesthetic outcome. Materials and Methods: A 40 years old male with no medical history came to our hospital right after traumatic amputation and degloving injuries of his right index, middle and ring fingers. Free lateral arm fascial flap was used to cover the defects to preserve length of the digits. After the flap tissue became stable, the flap was reshaped with elastic cohesive bandage to near normal contour. Then we replace the previous split thickness skin grafts with full thickness skin grafts. Results: Reconstruction with free lateral arm fascial flap for patient with multiple digital defects followed by reshaping with elastic cohesive bandage was successful in soft tissue coverage to achieve good function in long-term follow up. The grip and pinch power are identical to ipsilateral hand. Conclusion: Hand is a unique region that contains important functional and aesthetic units. Reconstruction for composite defects in this region is highly challenging because it requires completely restoring those functions and aesthetics. We successfully rebuilt the hand units with free lateral arm fascial flap and elastic cohesive bandage for reshaping of contour. The reconstruction resulted in excellent outcomes. The nearly normal contouring provides complete daily function. The donor site outcome is also uncompetitive. Free lateral arm fascial flap may be the good choice for multiple digits composite defects patients. |
本系統中英文摘要資訊取自各篇刊載內容。