摘要
目的探讨应用携带（足母）趾胫侧舌状瓣重建甲侧襞的改良部分（足母）甲皮瓣联合髂骨移植再造拇指Ⅱ度缺损的临床效果。方法自2006年1月至2016年1月，我们根据拇指Ⅱ度缺损的特点，采用同侧携带（足母）趾胫侧舌状瓣重建甲侧襞的改良部分跨甲皮瓣联合髂骨移植再造拇指Ⅱ度缺损26例，均缝合神经重建感觉，供瓣区应用第二足趾侧方皮瓣联合植皮修复。术后随访时间为6～24个月，平均12个月。结果术后再造26例拇指全部存活，其中发生静脉危象1例，动脉危象1例，经及时手术探查，重新吻合血管后顺利存活，（足母）甲皮瓣携带的舌状瓣存活良好。再造拇指的甲侧襞外形满意，两点分辨觉4—7mm。（足母）趾供区无溃疡发生，外观有一定影响，而行走无影响。结论携带（足母）趾胫侧舌状瓣重建甲侧襞的改良部分（足母）甲皮瓣联合髂骨移植是再造拇指Ⅱ度缺损的理想方法之一。
Objective To evaluate the clinical effect of modified wrap-around flap from the big toe with a tibial tongue flap for lateral fold reconstruction combined with iliac bone graft in the management of Ⅱ degree thumb defect. Methods Based on the characteristics of the defects, Ⅱ degree thumb defects of 26 cases were treated between January 2006 and January 2016 using modified wrap-around flap from the ipsilateral big toe carrying a tibial tongue flap for lateral fold reconstruction combined with iliac bone graft. Sensory nerve was coapted in all the transplants to restore sensation. The donor sites were covered by lateral flap transfer from the second toe and skin graft. Postoperative follow-up ranged from 6 to 24 months, average being 12 months. Results All 26 reconstructed thumbs survived. One case had venous crisis and another case had arterial crisis, both of which survived after timely surgical exploration and vascular re-anastomosis. The tongue flap carried with the wrap-around flap also survived well. The lateral thumb nail fold reconstruction was satisfactory. Two-point discrimination of the reconstructed thumbs was 4 to 7 mm. There was no ulcer occurrence at the big toe donor site. Although there was impact on the appearance of the big toe, walking was not affected. Conclusion Modified wrap-around flap from the big toe with a tibial tongue flap for lateral fold reconstruction combined with iliac bone graft is an ideal method for treating Ⅱ degree thumb defect.
出处
《中华手外科杂志》
CSCD
北大核心
2017年第2期89-91,共3页
Chinese Journal of Hand Surgery
基金
国家临床重点专科基金,国卫办医函[2013]544
关键词
拇指
外科皮瓣
植骨
Thumb
Surgicalflaps
Bonegraft
