Simultaneous Reconstruction of Multiple Metacarpal Defects and Forearm Extensor Tendon Injury-A Case Report

一次性重建多個掌骨缺損和前臂伸肌腱損傷－病例報告

王彥博(Yan-Bo Wang) ； 張世幸(Shih-Hsin Chang) ； 黃文成(Wen-Chen Huang) ； 董光義(Kuang-Yi Tung)

《臺灣整形外科醫學會雜誌》 23卷1期 (2014/03) Pp. 82-89

摘要

背景：嚴重毀損的手和前臂背側外傷是重建外科醫師的挑戰。手背的皮膚，肌腱和骨頭的共同缺損往往需要顯微外科自由皮瓣重建，在創傷區裡受供應血管受傷的可能性更增加了重建的難度。目的及目標：在本病歷報告中我們利用兩個游離皮瓣一次性地重建前臂及手部缺損。材料及方法：68歲男子在中國大陸被落石擊中導致右前臂和手砸傷，10天後患者被轉診至本院所。我們進行廣泛的清創之後，病人在右前臂和手背側有大範圍軟組織缺損和第三第四掌骨缺損。我們採用左腓骨自由皮瓣和帶闊筋膜的右大腿前外側自由皮瓣進行單一階段的複合重建。結果：這病人在一次手術中同時達到骨與肌腱缺損修復和軟組織覆蓋。術後恢復順利。重建9個月後整體輪廓和外觀令人滿意，並可以實現基本的手部功能，追蹤的X光片顯示理想的骨癒合。結論：在手部嚴重外傷病人一階段式的重建中，憑藉清創、仔細重建和細緻手術技術可以達到肢體的保留和可接受的外觀與功能。

並列摘要

Background:Severe mutilating injuries to the dorsum of the hand and forearm pose challenges to reconstructive surgeons. The combined loss of skin, tendons, and bones on the dorsum of the hand often necessitates free tissue transfers, and the possibility of simultaneous trauma to the recipient vessels increases the difficulty of microsurgical reconstruction.Aim and Objectives:We present a case of a patient with multiple metacarpal defects and forearm extensor tendon injury, who underwent simultaneous reconstruction of the forearm and hand defects with 2 free flaps in a 1-stage surgery.Materials and Methods:A 68-year-old man sustained an injury to his right forearm and hand caused by a falling stone in mainland China. He was transferred to our center 10 days after the injury. Extensive debridement was first performed. Several days later, a 1-stage composite reconstruction was performed with a left fibula osteoseptocutaneous free flap and a right anterolateral thigh free flap containing fascia lata.Results:The postoperative course was uneventful. The overall postoperative contour and appearance were satisfactory to the patient, and basic hand function was recovered 9 months after the surgery, with radiographs revealing good bony union.Conclusion:In such a severely damaged case, limb salvage with optimal aesthetic and functional outcome can be achieved with meticulous wound debridement, detailed reconstructive plans, and delicate surgical technique.

並列關鍵字

hand reconstruction ； anterolateral thigh flap ； fibular osteoseptocutaneous flap