目的 探讨双边多三角形对顶设计旋股外侧动脉降支穿支皮瓣移植修复手前臂软组织缺损的应用方法及效果.方法 自2019年2月至2021年6月,我科应用双边多三角形对顶设计旋股外侧动脉降支穿支皮瓣移植修复手前臂软组织缺损患者9例,均伴有不同程度的骨与关节或肌腱等深部组织外露.均于大腿切取旋股外侧动脉降支穿支皮瓣.皮肤缺损面积为18 cm×9 cm～22 cm×10 cm,术前根据受区创面的形状,在皮瓣纵轴双边设计多个对顶三角形,两侧三角尽量彼此交错分布,尽量避免三角形顶部与穿支在同一平面,皮瓣切取面积为23.0 cm×9.5 cm～28.0 cm×10.0 cm.皮瓣移植修复前臂手部创面,吻合供区与受区血管,重建皮瓣血运.供区均直接闭合.术后观察临床疗效.结果 术后9例皮瓣全部存活,无血管痉挛及危象发生,皮瓣切取宽度为9.5～10.0 cm,供区创面均能直接拉拢缝合.术后随访10～32个月,平均18个月.皮瓣供区线性瘢痕愈合,无裂开及伤口周围皮缘坏死现象,无肌疝发生,皮瓣质地柔软,弹性好,肤色接近正常皮肤,其中2例皮瓣略显臃肿,术后半年进行二次整形.患侧手关节屈伸功能满意.同侧膝关节活动好.结论 采用双边多三角形对顶设计旋股外侧动脉降支穿支皮瓣移植修复手前臂软组织缺损,能最大程度地减轻供区缝合张力,尤其对于切取宽度小于10 cm的皮瓣供区,能实现供区一期闭合,具有临床推广价值.

目的:介绍多小切口联合末节指骨骨隧道缝合法治疗腱性锤状指畸形的手术方法及临床疗效。方法:自2019年6月至2021年10月，烟台山医院手外科采用多小切口联合末节指骨骨隧道缝合法治疗腱性锤状指畸形9例，均为单指、闭合性新鲜损伤，男7例，女2例；年龄23~51岁，平均36岁；受伤至手术时间3~10 d。于近端小切口内缝线套圈缝合肌腱断端近侧，向远端牵拉并通过远端骨隧道打结固定，克氏针固定远侧指骨间关节（DIP）背伸位，肌腱断端间断加强缝合。术后予石膏托功能位保护性固定3周，3周后掌指关节及近侧指骨间关节（PIP）正常活动，6周后拔除克氏针。出院后采取门诊、微信等方式随访，观察患指外形及功能。结果:术后随访时间为6~17个月，平均9个月。术后切口均一期愈合，无感染，无皮肤坏死及线结外露等并发症，采用美国手外科学会推荐的总主动活动度（TAM）功能评定法评定DIP活动，优7例，良2例。结论:采用多小切口联合末节指骨骨隧道缝合法治疗闭合性腱性锤状指畸形，能实现肌腱断端低张力连接，手术创伤小，并发症少，是一种治疗腱性锤状指的有效方法。

Objective:To explore the clinical application of the posterior tibial artery perforator flap with the great saphenous vein (GSV) in the treatment of severe degloving injury of the forearm.Methods:From June 2015 to October 2020, 5 patinets (4 males and 1 female, aged 20-46 years old, mean age 37 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital in Yantai. Aposterior tibial artery perforator flap with GSV was used to repair the partial wound of the injured forearm, together with the establishment of venous circulation of dorsal hand for all 5 patients. All the patients suffered from severe forearm degloving injury. Of which, 3 accompanied with ulna radius fracture, 2 with ulnar and radial artery injury and 2 with blood supply insufficiency in the injured fingers. The sizes of soft-tissue defect were 26 cm×18 cm-32 cm×25 cm. The sizes of the posterior tibial artery perforator flap with GSV ranged from 12 cm×5 cm to 33 cm×6 cm. The anastomoses were performed on the perforating artery and the radial artery. The GSV was anastomosed with cephalic vein with bridging anastomosis to re-establish the venous circulation of dorsal hand. Combined anterolateral thigh flaps (ALTF) were used to repair the rest wound of injured limbs in 4 patients, and the combined pedicled abdominal flap was used in 1 patient. The donor site of calf flap was sutured directly, and the skin of upper limb was thinned into medium thick to cover the thigh flap donor site, which was packed with pressure dressing. Regular follow-up reviews were carried out by outpatient clinic, telephone, WeChat APP or home-visit after the operation to observe the survival of flaps, the swelling of the distal end of injured limb, functional recovery and healing at the donor site. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the grafted flaps in 5 patients survived. Necrosis at epidermal edge occurred in 1 calf flap, and achieved secondary healing after dress changing for 4 weeks. There was neither arterial nor venous crisis in all flaps. The oedema of the hand disappeared within 4-8 weeks, with clear dermatoglyph. There was no obvious enlarged circumference of thumb and fingers. The follow-up was carried out for 8-20 months, with 11 months in average. The flaps were elastic in good colour, and full texture without pigmentation. The donor site of the calf flap showed a linear scar. No swollen was seen in the hands of the injured forearm and the feet of donor lower legs. The range of motion of phalangeal joints was good. Recovery of finger sensation achieved at S 4. The recovery of the sensation of posterior tibial artery perforator flap reached S 3 in 2 patients and S 2 in 3 patients. Assessment of the Upper Limb Function using the Standard Issued by the Hand Surgery Society of Chinese Medical Association rated excellent in 3 patients and good in 2 patients. Conclusion:The posterior tibial artery perforator flap with GSV has a reliable blood supply with a small damage to the donor site. This flap is ideal for repair of severe degloving injury of forearm and meanwhile to achieve the re-establishment of venous circulation in dorsal hand.

目的 探讨应用不带阔筋膜的股前外侧皮瓣移植修复小儿轮辐伤致足踝皮肤缺损的临床效果.方法 对2013年5月至2016年10月山东省烟台市烟台山医院手外一科采用不带阔筋膜的股前外侧皮瓣移植治疗的轮辐伤致足踝皮肤缺损患儿6例的临床资料进行回顾性分析.其中男3例,女3例,平均年龄6(4～12)岁;均为电瓶车或摩托车轮辐伤;皮肤缺损部位:足背4例,足跟2例;皮瓣面积4 cm×10 cm～15 cm×8 cm.全部患儿在接受一期手术行创面清创、骨折固定、肌腱修复、负压封闭引流(VSD),待创面稳定且无异常分泌物之后,二期行超薄游离股前外侧皮瓣移植修复.术后平均随访时间为16(6～22)个月.观察受区创面皮瓣外观与质地;采用中华医学会肢体功能评定试用标准对下肢功能进行评价.结果 二期修复手术平均用时4(3～5)h,术中平均出血量为75(60～100)ml.6例皮瓣均顺利成活,无血管危象发生;皮瓣血运良好,质地薄而柔软,无臃肿,外形满意,无需二次手术整形;下肢皮肤未见明显瘢痕挛缩及色素沉着,恢复深浅感觉;邻近关节屈伸活动无明显受限,下肢功能均为优.结论 应用不带阔筋膜的股前外侧皮瓣移植修复小儿轮辐伤致足踝皮肤缺损,可获得良好的临床效果.

目的 探讨桡神经非创伤性神经束扭转的临床诊断及治疗.方法 回顾性分析我科自2007年至2015年收治的4例桡神经沙漏样改变患者资料.其中男2例,女2例;年龄26～38岁,平均31.8岁.病程2～5个月;患病前有过度疲劳史1例,吹空调受凉2例,无明显诱因1例.前根据临床体征及电生理检查,明确为周围神经损伤;超声检查确定神经病变位置、节段数量、狭窄程度.4例患者受累神经均为单侧桡神经,其中多段神经束扭转2例,单一部位神经束扭转2例.结果 4例非创伤性神经损伤患者经过积极手术治疗,术后6～8个月逐步出现伸腕、伸指及伸拇功能,术后1～2年随访时手功能恢复良好.结论 结合病史及临床表现,电生理检查为神经损伤,应用超声检查发现神经有明显缩窄存在时,需尽早行手术干预,促进神经恢复.

目的:探讨应用腕部"H"型深、浅静脉联合移植修复掌浅弓缺损的临床效果。方法:自2008年10月至2015年8月,共收治手部严重挤压伤伴掌浅弓缺损16例,均为手掌部严重创伤,伴有皮肤、掌骨、肌腱、神经及掌浅弓的损伤,创面以远手指组织无血运,手掌部软组织缺损面积为2.0 cm×3.0 cm～10.0 cm×7.0 cm。设计应用腕部"H"型深、浅静脉联合移植修复动脉弓缺损,对其中7例软组织缺损者同时行游离股前外侧皮瓣覆盖创面,5例行腹部皮瓣覆盖,4例行游离植皮术。出院后通过微信和门诊复查的方式进行随访。结果:16例患者手指血运良好,皮瓣完全成活。其中受区创面15例一期愈合,1例游离植皮坏死,遗留创面经过换药后愈合；供区出现1例剥离皮肤坏死,行游离植皮后皮片成活,余供区切口一期愈合。术后随访5～25个月,根据中华医学会手外科学会上肢部分功能评定试用标准评定患肢受区手部功能：优9例,良5例,差2例。结论:腕部"H"型深、浅静脉具有解剖位置相对恒定、表浅、取材方便等优点,利用其修复掌浅弓缺损,能获得良好的临床疗效。

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation.Methods From January,2013 to October,2017,29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair.Fifteen cases treated with multiple end-to-side anastomosis on flap arteries,and 2-3 arteries were anastomosed,with the average of 2.13.Nine cases were treated with venous multiple end-to-side anastomosis,and 2-4 veins were anastomosed,with the average of 3.11.Five cases treated with arterial and venous multiple end-to-side anastomosis,and 4-6 vessels were anastomosed,with the average of 5.20.Distribution of wounds:10 cases with hands and wrists wounded,15 cases with forearms and elbow joints wounded,and 4 cases with lower legs and feet wounded.The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm,and the flap area was 6 cm× 15 cm-12 cm×29 cm.Postoperative followed-up was performed every 3-6 months to review flap survival.Results All flaps of 29 cases survived.Venous congestion occurred in 2 flaps within 48 h after the operation,among which,1 was overcomed after released the dressing and sutures,and the other underwent surgical exploration.The venous end-to-side anastomotic stomas were unobstructed,and hematoma was formed.After the hematoma compression was removed,circulation was recovered and the flap survived.With followed-up for 6 months to 2.5 years,both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder.Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.

Objective To explore the anatomic basis of anterior lateral malleolar venous network graft for repair of superficial palmar arch defects and report its clinical efficacy.Methods Microsurgical anatomical study was performed in 6 specimens of fresh Chinese adult lower extremities to observe and measure the branches,distribution,vessel length,caliber and venous valve characteristics of the anterior lateral malleolar venous network.From May 2007 to February 2017,15 patients with superficial palmar arch defects were treated by anterior lateral malleolar venous network graft.Results Anatomical study results showed that there was a obviously visible venous network in the superficial fascia of the anterior lateral malleolus.The distal end was originated from the fibular side of the arcus venosus dorsalis pedis,and the proximal vessels flowed into the great saphenous vein medially and the small saphenous vein laterally.Between them,there were 4 to 6 fine veins that formed network.The length of the distal dorsal segment of small saphenous vein (BC) was (2.81±0.39) cm.The branch length of the anterior lateral malleolar venous network (CD) was (5.32±0.92) cm.The fibular side vascular diameter of arcus venosus dorsalis pedis was (2.15±0.35) mm.The proximal end of the vascular network had 4.8 branches.The diameter of the vascular branch at the tip of the lateral malleolus E line horizon averaged (1.06±0.43) mm.There are an average of 4.2 valves per anterior lateral malleolar venous network.The valves in branches are toward the proximal direction.Clinically,15 cases of superficial palmar arch defects were treated by anterior lateral malleolar venous network graft with a total of 54 anastomosis sites of distal area of recipient area and an average of 3.6 anastomosis sites per case.Postoperatively,1 case suffered partial distal thumb necrosis and the rest of the distal fingers survived uneventfully.The follow-up time ranged from 6 months to 5 years and 3 months in 12 cases.The appearance of the hand was good,and the function of holding and opposition movement was restored.The finger proprioceptive sense was recovered.The two-point discrimination was 5 to 7 mm.According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association,the results were graded as excellent in 6 cases,good in 4 cases,fair in 1 case and poor in 1 case.There was no influence on the function of donor site.Conclusiou The anatomy of anterior lateral malieolar venous network is constant.Its shape,diameter and number of branches are similar to the superficial palmar arch.The valve opening is toward the proximal end.It is an ideal method for repairing the defects of superficial palmar arch.

目的 探讨一类有明确手术适应证的尺骨茎突骨折.方法 2012年1月-2014年4月,收治61例桡骨远端骨折合并尺骨茎突骨折患者(单纯对桡骨远端骨折行钢板内固定),其中尺骨茎突Ⅰ型骨折40例,Ⅱ型骨折21例,Ⅱ型中包含一类特殊类型骨折(骨折累及尺侧腕伸肌腱沟)12例.术后随访10~21个月,重点关注下尺桡关节稳定性,并对腕关节功能进行评定.结果 40例Ⅰ型骨折未出现下尺桡关节不稳或疼痛不适;21例Ⅱ型骨折中,14例出现腕关节背伸、尺偏时的疼痛不适,其中12例特殊类型骨折均包含在内,出现尺侧腕伸肌的掌侧滑脱并腕关节持重时无法缓解的疼痛不适、弹响及抗阻力的肌力下降.结论 累及尺侧腕伸肌腱沟的Ⅱ型尺骨茎突骨折,作为一类以往我们未曾专门划分的特殊类型的骨折,有明确的手术指征.

目的：探讨钩骨骨折合并第4，5腕掌关节脱位的临床诊断及漏诊原因。方法结合本组病例X线片的典型特点、临床体征及诊断，对钩骨—腕骨关节脱位反复漏诊的患者进行回顾性分析。结果对此病诊治临床思维的欠缺，是造成反复漏诊的主要原因。结论虽然钩骨骨折合并第4，5腕掌关节脱位漏诊率极高，但临床医生通过必要的检查及注意必要临床思维的培养，可以减少漏诊的发生。

目的 介绍应用(拇)横动脉蒂(拇)趾腓侧岛状皮瓣修复第二足趾供区创面的手术方法及临床效果.方法 对18例切取第二足趾移植再造拇、手指后遗留的足部供区创面,应用带(拇)横动脉蒂(拇)趾腓侧岛状皮瓣转位覆盖,皮瓣切取面积为2.6 cm×1.6 cm～3.2 cm× 2.0 cm.结果 术后再造拇手指全部存活,(拇)趾腓侧皮瓣能有效覆盖足趾供区骨外露创面且全部存活.术后随访时间为8～26个月,再造拇手指外形和功能良好,指腹两点分辨觉为6～8mm,触觉恢复,痛、温觉良好.(拇)趾腓侧岛状皮瓣无臃肿,全部患者均保留了第二跖骨头,其中7例保留了第二趾骨近节基底部,足部外观良好,供足穿鞋、行走功能无影响.足功能分析显示,动态、静态足底应力分布与健侧十分接近,患者步态正常.结论 横动脉蒂(拇)趾腓侧岛状皮瓣解剖位置恒定,血液供应良好,手术方法简单、安全,是修复第二足趾供区创面的理想方法.