[足母]甲瓣切取术后创面的处理  

Treatment of the donor site after wrap around flap from toe

作　　者：王保山 郑晓菊 王新宏 高树林 

机构地区：[1]陕西省西安市凤城医院手足显微外科,710016 [2]辽宁省朝阳县医院骨科

出　　处：《中华显微外科杂志》2009年第1期26-28,共3页Chinese Journal of Microsurgery

摘　　要：目的探讨[足母]甲瓣切取术后创面的覆盖办法。方法对34例病例其中[足母]甲瓣再造拇指8例：[足母]趾腓侧半趾甲瓣移植22例（再造拇指8例、示指10例、中指2例）；[足母]趾背侧甲瓣移植4例，对供区创面采用了带蒂皮瓣（第一跖背皮瓣、第二足趾趾动脉岛状瓣、第二足趾趾背邻趾皮瓣、跗外侧皮瓣）；游离皮瓣（跖底内侧皮瓣、腓动脉皮瓣、跗外侧皮瓣）等覆盖。结果术后2个月内随访12例，步态正常：4个月随访6例（4例为第一跖背皮瓣、1例腓动脉皮瓣、1例跖底内侧皮瓣）。2例皮瓣有保护性的感觉，颜色略黑；跖底内侧皮瓣和第二趾动脉皮瓣，感觉正常。对供区创面用皮瓣修复其外形丰满有弹性，[足母]趾腓侧半趾甲瓣用皮瓣修复的[足母]趾外形酷似原[足母]趾，趾甲皮瓣移植修复外形佳，形成瘢痕少；步态正常；供趾无不适感。结论[足母]趾切取甲瓣、[足母]趾腓侧半侧甲瓣、[足母]趾背侧甲瓣后遗留创面采用皮瓣修复既可避免疼痛、破溃等并发症，又使供足有满意的外形，因此是一种理想的修复方法。Objective To investigate the methods to cover the donor site of wrap around flap from toe. Methods In 34 cases, 8 thumbs reconstructed with wrap around flap from great toe, 8 thumbs and 14 fingers reconstructed with half nail flap from fibular side of second toe, and 4 fingers reconstrueted with dorsal nail flap from second toe. The donor site were covered with pedicle flap （first metatarsal dorsal flap, second toe digital flap, neighbor flap from dorsal of second toe, and lateral tarsus flap） or free flap （medical plantar flap, fibular artery flap, and lateral tarsus flap）. Results Twelve cases were followed up after 2 months, normal gait were found, 6 cases were followed up after 4 months, （4 cases for first metatarsal dorsal flap, one for fibular artery flap and one for internal volar flap）. 2 cases recovered defend sensibility and showed a bit dark, the cases which reconstructed with medical plantar flap and second toe digital flap had nearly normal sensibility. The outward appearance of the donor site were chubbiness, flexible, and no complaint were found. Conclusion Covered the donor site of wrap around flap from toe with these flaps can avoid complications like pain and ulcerate, and have a satisfactory appearance.

关 键 词：趾甲瓣 外科皮瓣 移植 显微外科 

分 类 号：R658.2[医药卫生—外科学] R697.120.7[医药卫生—临床医学]