摘要
目的探讨游离[足母]甲皮瓣移植再造拇指的方法及临床疗效。方法自2015年1月-2021年6月,采用游离[足母]甲皮瓣及旋髂浅动脉穿支皮瓣移植再造拇指缺损15例。其中6例拇指为Ⅱ度缺损,4例为Ⅲ度缺损,均应用游离[足母]趾甲瓣组合髂骨再造;其余5例为拇指脱套伤应用单纯[足母]甲皮瓣再造。[足母]甲皮瓣供区应用游离旋髂浅动脉穿支皮瓣修复。出院后定期门诊随访,随访内容为观察[足母]甲皮瓣、供区旋髂浅动脉穿支皮瓣的外观、色泽、感觉、手指功能、指甲生长情况。结果本组15例[足母]甲皮瓣及旋髂浅动脉穿支皮瓣均成活。1例供区旋髂浅动脉穿支皮瓣术后24 h出现静脉危象,经换药、拆线,清除皮下血肿后静脉危象解除,皮瓣顺利成活。所有病例均获随访,随访时间6~18个月,平均12个月。15例[足母]甲皮瓣拇指外形美观,颜色接近对侧拇指,指甲生长良好;[足母]趾供区旋髂浅动脉穿支皮瓣血运良好,无明显臃肿、质地柔软,恢复保护性感觉;腹股沟供区仅遗留一道线状瘢痕。再造拇指功能按中华医学会手外科学会手功能评定试用标准评定:优8例,良5例,可2例。再造拇指腹部两点辨别觉6~12 mm。足趾供区均愈合良好,不影响足部行走、跑跳。结论游离[足母]甲皮瓣移植再造拇指Ⅱ、Ⅲ度缺损,再造拇指外形美观、感觉恢复佳,供区损伤小,是一种修复拇指缺损的良好方法。
Objective To investigate the method and clinical effect of transplantation of the free toe-nail flap to repair defects of thumb.Methods From January 2015 to June 2021,15 cases of thumb defects were reconstructed with free toe-nail flaps and superficial circumflex iliac artery perforator flaps.Among them,6 cases had gradeⅡdefects of thumb and 4 cases had gradeⅢdefecst,all of which were reconstructed with free toe-nail flaps combined with iliac bone;the remaining 5 cases were reconstructed with toe-nail flaps lonely for thumb degloving injury.The donor site of toe-nail flaps was repaired by freeing superficial circumflex iliac artery perforator flap.Regular outpatient follow-ups were performed after discharge,and the follow-up contents were to observe the appearance,color,feeling,finger function,and nail growth of the toe-nail flap and the perforator flap of the superficial circumflex iliac artery at the donor site.Results The 15 cases of toe-nail flaps and superficial circumflex iliac artery perforator flaps survived.One case of superficial circumflex iliac artery perforator flap developed venous crisis in 24 hours after surgery.After dressing change,suture removal,and removal of subcutaneous hematoma,the venous crisis was relieved,and the flap survived smoothly.All cases were followed up for 6 to 18 months,with an average of 12 months.The reconstructed thumbs in 15 cases had beautiful appearance,the color was close to the contralateral thumb,and the nails grew well.The superficial circumflex iliac artery perforator flap at the toe donor site had good blood supply,no obvious swelling,soft texture,and restored protective feeling.Only a linear scar remains at the inguinal donor site.The function of the reconstructed thumb was evaluated according to the hand function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association:8 cases were excellent,5 cases were good,and 2 cases were fair.The two-point discrimination on the abdomen of the thumb was 6-12 mm.The toe donor sites healed well and did not affect foot walking,running and jumping.Conclusion Free toe-nail flap to reconstruct theⅡandⅢdefects of thumb,the reconstructed thumb has beautiful appearance,sensation recovery well,and less damage to the donor site.It is a good method to repair thumb defects.
作者
杨小文
江吉勇
汪金平
曾凡雨
陈永健
YANG Xiaowen;JIANG Jiyong;WANG Jinping(Department of Hand and Foot Microsurgery,Shenzhen Overseas Chinese Hospital Affiliated to Jinan University,Shenzhen,Guangdong,528111,China)
出处
《实用手外科杂志》
2022年第3期315-317,共3页
Journal of Practical Hand Surgery
