急诊趾甲皮瓣移植再造拇指  

Reconstruction of thumb in emergency with great toe-nail flap transplantation

作　　者：辛畅泰[1] 曾宪利[1] 蔡林方[1] 

机构地区：[1]沈阳医学院附属中心医院手外科,110024

出　　处：《实用手外科杂志》1999年第3期138-139,共2页Journal of Practical Hand Surgery

摘　　要：目的介绍急诊趾甲皮瓣移植再造拇指的特点及经验。方法应用趾甲皮瓣移植的方法急诊为34例不同拇指损伤及缺损的病人施行了拇指再造术,在拇指骨支架的重建,受区血管的选择,供区创面的修复等方面进行了改进。结果本组34例,成活31例,失败3例。成活率达91%。术后经6个月至5年的随访,其成活的31例,再造之拇指外形佳,其中30例恢复了良好的感觉和运动功能。27例病人供区植皮全部或大部成活,拇趾无触痛,无创面,无明显功能障碍。4例供区植皮大部坏死,经切除末节趾骨后创面愈合,4例坶趾残端曾出现破溃,经换药后创面愈合,均不影响走路。结论急诊一期拇指再造有最大限度地保留伤指的正常组织,指骨可回植,手术一次完成,缩短治疗时间和减少医疗费用的优点。ve To introduce the feature and experiences in reconstruction of thumb in emergency with neurovascularized great toe-nail flap transplantation. Methods Reconstruction operations have been carried out on 34 patients suffering from various types of thumb injury and defect with great toe-nail flap transplantation. Improvement have been made in many aspects including reestablishment of bone frame, selection of recipient vessel, and repair of bonus trauma, etc. Results Among the 34 cases in this group, 31 survived and 3 failed. The survival rate reached 91 % . By 6 months to 5 years' follow-ups, the transplanted thumbs of the surviving 31 cases took on good appearances and 30 cases have recovered good seasation and exercise functions . And there are 27 cases all or most of whose donating area's replanting dermae survived, and there existed no haphalgesia or wound surfaces in the remained ends of the great toes, nor existed dysfunction. There are 4 cases most of whose donating area's transplanting derma died and after the phalangette was cut off the surface of the wound healed. There are 4 cases whose remained ends of the great toes once had ulceration, but after the dressing change the surface of wound healed, not affecting their walking. Conclusion This kind of procedure can preserve normal tissues of traumatic thumb as far as possible. The finger bone can be replanted primarily. The operation can be finished at one time so as to shorten the period and reduce the medical cost.

关 键 词：急诊 趾甲 皮瓣移植 再造拇指 指骨 创面 植皮 限度 目的 方法 

分 类 号：R658[医药卫生—外科学] R644[医药卫生—临床医学]