摘要目的 介绍严重前臂及手部外伤的修复与功能重建的方法.方法 对26例严重前臂及手部外伤,采用显微外科方法进行修复与功能重建.软组织缺损面积4 cm×5 cm～ 20 cm×8 cm,均伴有不同程度的骨骼、肌腱、血管及神经的外露或缺损,其中患肢血液循环完全丧失15例,伴有大段血管缺损8例,伴有神经缺损5例.结果 术后随访时间为6个月至5年,平均20个月,26例肢体全部存活.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:优13例,良9例,可3例,差1例；优良率为84.6％.结论 严重前臂及手部外伤是一种复杂而严重的损伤,正确评估损伤肢体的血液循环及软组织损伤程度和缺损的范围,确定缺损且要重建的结构,合理设计手术方案,采用显微外科方法修复,先恢复患肢血液循环,同期或分期进行功能重建,以挽救一些符合截肢指征的肢体.

abstractsObjective To introduce the methods for repairing severe forearm and hand injuries and functional reconstruction.Methods Microsurgical techniques and procedures were employed to treat 26 cases with severe forearm and hand injuries.The affected areas of tissues were 4 cm × 5 cm to 20 cm × 8 cm,where bones,tendons,blood vessels and nerves were either exposed or missing to different degrees.Among 26 cases,there were 15 cases with complete loss of blood supply,8 cases with long defect of blood vessels and 5 cases with defect of nerves.Results Postoperative follow-up ranged from 6 months to 5 years,with an average of 20months.All 26 repaired and reconstructed forearm or hand survived.According to the upper llmb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,the outcomes were rated as excellent in 13 cases,good in 9 cases,fair in 3 cases and poor in 1 case,achieving an overall 84.6％satisfactory rate.Conclusion Severe injury and defect of the forearm and hand is complex.Accurate assessment of the blood circulation and the extent and severity of tissue injury,and designing surgical procedures accordingly are critical.Restoration of the blood supply using microsurgical techniques and simultaneous or staged functional reconstruction can salvage some limbs that would otherwise be amputated.