足趾移植拇指再造的美学原理及拇指缺损分类  

The Types of Defect of the Thumb and the Aesthetic Principle of Thumb Reconstruction by Toe-to-Hand Transfer

作　　者：王炜[1] 杨志贤[2] 戴传昌[1] 董佳生[1] 林晓曦[1] 祁佐良[1] 邹丽剑[1] 张涤生[1] 

机构地区：[1]上海第二医科大学附属第九人民医院整形外科,200011 [2]青岛中国人民解放军401医院

出　　处：《组织工程与重建外科杂志》2005年第3期123-127,共5页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的研究拇指缺损的分类及拇指再造的美学原理和方法。方法回顾27年以来390例足趾移植拇指及手指再造经验,根据拇指缺损的类型,选择足趾移植方法;有目的地选择大足趾包裹皮瓣移植拇指再造。对移植的第二足趾进行外科美学雕塑:包括鼓锤样趾肚侧方缩小;跖趾关节臃肿软组织微创切除;跖趾关节腹侧关节囊松弛紧缩;跖趾关节近心端跖背三角形皮瓣大小确当;跖底三角形皮瓣削薄;拇伸肌腱鱼口加编织高张力吻合;拇屈肌腱鱼口加编织低张力吻合,增加吻合肌腱早期活动牵引的承受能力;骨钉加骨楔状吻接,双向钢丝固定;术后第一天开始早期功能训练。设计“型、级”拇指缺损的分类体系。结果按照解剖学及美学原理对移植足趾拇指再造的供区及受区进行改造,使足趾移植,或是扩大足趾移植,或是部分足趾移植再造的拇指形态逼真,功能良好。拇指缺损的“型、级”分类体系,有6型12级;结论经过外科美学雕塑和早期功能训练的足趾移植后,使再造拇指达到形态逼真,功能活动良好。拇指缺损的“型、级”的分类体系,可作为拇指缺失拇指再造手术方法选择的依据,和功能评定的参考。Objective To study the classification of thumb defect and the aesthetic principle of thumb reconstruction by toe-to-hand transfer. Method The classification of thumb defect is following the system of types and grades. The authors analysed 390 cases of toe-to-hand transfer for the thumb or finger reconstruction from 1973-2000 years. The principle for the aesthetic and functional thumb reconstruction is to selected good indications and good condition of the transferred second toe. One need to sculpture the transferred second toe and designed a new method for the bone and tendon repair during the procedure of thumb reconstruction, in order to arrange early stage physical functional training postoperatively. Result The classification of the thumb defect is divided six types and twelve grades, The reconstructive thumb can get full range of motion in the MP and/or PIP joint, and the shape of the thumb is near normal postoperatively. Conclusion The classification of thumb defect with six types and twelve grades could help to make good indication for the thumb reconstruction and its functional evaluation postoperatively . The reconstructive thumb can get full range of motion at the MP and/or PIP joint, and with good appearance near normally. It is very important that the transferred second toe to be sculptured and made a new design for the bone and tendon repair during the procedure of thumb reconstruction, in order to arrange early stage physical functional training post operation of thumb reconstruction.

关 键 词：足趾移植 分类 拇指缺损 

分 类 号：R658.1[医药卫生—外科学]