不带趾骨的游离趾甲皮瓣再造拇指  

Thumb Reconstruction with Free Big Nail Skin Flap without Phalanx

作　　者：冯亚高[1] 洪光祥[2] 张向宁[1] 付鲲鹏[1] 魏斌[1] 

机构地区：[1]解放军252医院手足外一科,河北保定071000 [2]华中科技大学同济医学院协和医院手外科,湖北武汉430022

出　　处：《实用骨科杂志》2009年第8期585-586,共2页Journal of Practical Orthopaedics

摘　　要：目的观察不带趾骨的游离趾甲皮瓣移植重建拇指的临床效果。方法对9例拇指缺损、拇指皮肤撕脱伤及拇指再植术后坏死病例进行保留趾全长的游离趾趾甲皮瓣移植重建,其中拇指缺损4例,拇指皮肤撕脱伤3例,拇指再植术后坏死2例。亚急诊再造5例,择期再造4例。结果再造拇指全部成活,经随访1～6年,再造拇指外形美观,对掌活动灵活,再造拇指抓、握、捏有力,两点辨别距离8～12mm,患者对再造拇指均满意。供区足母甲皮瓣切取后植皮大部分成活,部分病例经甲壳胺人工皮膜局部使用后创面愈合。趾均保留了全长,无破溃及疼痛病例,术后对供足的站立行走及负重功能无明显影响。结论不带趾骨的游离趾甲皮瓣移植再造拇指具有外形逼真、功能恢复好、疗程短、对供区外形及功能影响小、患者易接受等优点,是治疗拇指皮肤撕脱伤、Ⅲ～Ⅳ度拇指缺损及再植术后拇指坏死补救的理想手术方法。Objective To observe clinical result of thumb reconstruction with big nail skin flap without phalanx. Methods 9 patients who had accepted thumb reconstruction with big nail skin flap by keeping the length of the toe. there were 4 cases with defected thumb, 3 cases with avulsed skin injury of thumb,and 5 with necrosis of replantative thumb. Results All cases followed up from one to six years,nine reconstructive thumbs were survived,and all patients were satisfied with the reconstructive thumb. All reconstructive thumb has a good appearance and good sensory and motor functions recovery. All patients retain the length of the donor toe with no pain and no ulcer, the walking and stand-bearing function of donor foot were less impact after operation. Conclusion Thumb reconstruction with big nail skin flap without phalanx is an ideal method to reconstruct defected thumb within Ⅲ～Ⅳ degree,skin avulsed injury of thumb and remedy necrosis of replantative thumb. This operation is easily accepted by patients ,has a short period and less damage on donor area,and reconstructive thumb has a good appearance and good function recovery.

关 键 词：[足母]趾甲皮瓣 拇指再造 

分 类 号：R622.1[医药卫生—整形外科]