摘要
目的探讨第一趾和第二趾组合移植再造拇指，同时I期行再造拇指外形修饰的临床效果。方法应用第一趾和第二趾趾背皮甲瓣互换，联合第二趾肌腱一骨一趾腹组织复合体组合再造Ⅲ、V度缺损拇指15例，同时利用拇趾趾背皮甲瓣携带的腓侧三角形皮瓣嵌入第二趾中部趾腹最细处，以增大其周径，I期重塑再造拇指外形。拇趾皮甲瓣供区用第二趾皮甲瓣或＋游离植皮修复。结果15例再造拇指全部成活，12例获随访12～24个月。再造指与健侧指体长度一致，背侧外观接近健侧拇指，再造拇指中节趾腹最细处周径较第二趾平均增加20mm，供足拇趾完整，供足行走无明显影响。再造指两点辨别觉为5．5～9．0mm，平均为7．0mm。功能恢复良好。参照TAM系统评价：优6例，良5例，可1例；总优良率为91．7％。结论此方法再造拇指是一种较理想的方法，术后再造拇指外形及功能较传统第二足趾移植再造得到较明显改善，具有一定的临床应用价值。
Objective To investigate the method of reconstructing thumb by comprehensive transplantation of first toe and second toe accompanying reshaping of the reconstructed thumb primarily. Methods Totally 15 cases varying with HI to V degree thumb defect were treated by composite toe transfer to reconstruct the thumb by inter- changing the whole skin-nail flap from the first toe with the second toe and combined with metatarsophalangeal joint and tendon from the second toe. To thicken the narrow of the second toe, the great toe fibular skin flap embedded in the second toe in order to reshape it primarily. The second toe dorsal flap or free flaps were used to repairing great toe nail-skin flap. Results There were 15 cases in the group, and all reconstructed thumbs survived. During the follow up examination made from 12 to 24 months （average 18 months） in 12 cases after operation, the surviving fin- gels all preserved usual length, fine-looking appearance. The diameter of the reconstructed thumb pulp in finest site increased by 20 mm in average compared with the second toe. The great toe of donor foot was perfect and walking was not affected. Two-point discrimination found to be between 5.5 -9.0 mm, with an average of 7.0 ram. The recon- structed thumbs got normal function. Postoperative results were evaluated using the criteria for function of reconstruc- ted thumb and fingers issued by TAM. The results were graded as excellent in 6 cases, good in 5 cases and fair in 1 case. Excellent and good rate were 91.7%. Conclusion Second toe transfer and shape remodeling is an ideal method of thumb reconstructing. Compared to results after the traditional second toe transfer, the appearance and function of the thumb reconstructed by the new procedure were improved. So it is suitable for clinical application.
出处
《中国美容整形外科杂志》
CAS
2015年第10期614-617,共4页
Chinese Journal of Aesthetic and Plastic Surgery
基金
广东省中山市医学科研基金立项课题（J2012174）
关键词
拇指缺损
第一趾和第二趾趾背皮甲瓣
互换再造
Thumb defect
Skin-nail flaps of the first toe and the second toe
Interchange reconstruction
