足趾皮瓣游离移植修复拇指和手指皮肤缺损效果  

REPAIR OF CUTANEOUS DEFICIENCY OF THUMBS AND FINGERS BY TRANSPLANTATION OF FREE TOE FLAP

作　　者：侯书健[1] 杜玉凤[2] 迟焕芳[1] 程国良[3] 刘亚平[3] 王振军[3] 孙乐天[3] 

机构地区：[1]青岛大学医学院人体解剖学教研室,山东青岛266021 [2]青岛市海慈医院 [3]中国人民解放军第401医院手外科

出　　处：《青岛大学医学院学报》2009年第4期353-354,358,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨6种足趾皮瓣游离移植修饰性修复拇、手指皮肤缺损的疗效。方法1998年1月-2008年6月,采用6种足趾皮瓣游离移植修复拇、手指皮肤缺损82例。其中,吻合血管的趾腓侧趾腹皮瓣移植修复拇、手指指腹缺损22例;吻合血管的第二趾胫侧皮瓣移植修复拇、手指指腹缺损5例;吻合血管的趾甲瓣移植修复指甲缺损6例;拇甲瓣或第二趾趾甲皮瓣移植修复拇、手指皮肤套状撕脱伤37例;拇趾近节腓侧半月形皮瓣移植修复拇、手指近节与（或）中节皮肤环形缺损7例;拇趾末节腓侧半复合组织瓣或第二趾胫侧半复合组织瓣移植修复拇、手指末节半侧缺损5例。结果成功81例,成功率为98.8%。术后经0.5-5.0年（平均1.5年）的随访,皮瓣血运、质地、弹性及拇、手指外形良好,修复的指腹二点辨别觉为5-8 mm,6例移植指甲外观、生长良好。结论针对性采用6种类型的足趾皮瓣游离移植是修复拇、手指特定部位皮肤缺损的理想方法。Objective To report the outcome of six types of free toe-flap grafting for the repair of cutaneous deficiency of thumbs and fingers. Methods The six types of the procedure was performed in 82 cases, from January 1998 to June 2008, with cutaneous deficiency. Of whom, 22 cases were repaired by free flap from great toe; five of finger pulp defect were repaired by free flap from tibular side of the second toe; six with loss of nail were repaired with free onychocutaneous flap from great or the second toe; 37 with degloving injury of thumb or finger were reconstructed with wrap-around flap of great or the second toe; seven with ring-like skin defect at proximal thumb segment or at middle and/or proximal finger segment were repaired with semi-lunar flap from fibular side of proximal great toe; five with longitudinal subtotal loss of distal thumb and finger were repaired using fibular segmental osteo-onychocutaneous flap from great toe or tihial segmental osteo-onyehocutaneous flap from the second toe. Results The surgery succeeded in 81 cases, the suecess rate being 98.8%. Postoperative following-up from six months to five years showed the blood-supply, texture and elasticity of transferred flaps and shape of toes and fingers were excellent. Two point discrimination of the finger pulp was 5-8 mm. The appearance and growth of six transplanted nails were good. Conclusion Using the six types of free grafting of toe flaps for repairing cutaneous deficiency of thumbs or fingers is an ideal modality.

关 键 词：外科皮瓣 趾骨 组织移植 拇指 手指 皮肤缺损 

分 类 号：R658.2[医药卫生—外科学]