足拇趾甲瓣与第2趾趾骨皮瓣组合再造拇指术  

Thumb reconstruction with combined free hallux toe-nail flap and bone and skin flap of the 2nd toe transplantation

作　　者：王爱国[1] 张卫兵[1] 殷为华[1] 

机构地区：[1]南京大学附属南京鼓楼医院骨科(手足显微外科),江苏南京210008

出　　处：《临床骨科杂志》2009年第6期615-617,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨应用足拇趾甲瓣与足第2趾趾骨皮瓣组合再造拇指的临床应用价值。方法12例（13指）拇指缺损平面：Ⅰ度缺损3例3指,Ⅱ度缺损5例6指,Ⅲ度缺损2例2指,Ⅳ度缺损1例1指,Ⅴ度缺损1例1指。依据手指缺损的长度和范围设计拇趾趾甲瓣与第2足趾趾骨皮瓣切取范围,第2趾携带胫侧皮瓣。末节再造者8例9指,其拇趾供区全厚植皮,第2趾创面直接闭合;4例4指应用第2趾甲皮瓣修复拇趾趾创面。结果12例均获随访,时间28个月。再造指全部成活12指,甲床部分坏死1指。再造指感觉运动功能及外观功能满意。按赵书强手功能评定标准：优3例,良9指,可1指。足供区外观功能均满意。结论足拇趾甲瓣与第2趾趾骨皮瓣组合再造术是解决拇手指缺损的有效方法。Objective To evaluate the application and outcome of thumb reconstruction with combined free hallux toe-nail flap and bone and skin flap of the 2nd toe transplantation.Methods 12 cases（13 fingers） with finger defects were recruited.Based on length and extent of finger defect,free toe-nail flaps and bones flaps with the tibial skin flaps of the 2nd toe were designed.3 fingers in 3 cases with the thumb Ⅰ degree defect.Among all cases were reconstructed,6 fingers in 5 cases with the Ⅱ degree defect were reconstructed,2 fingers in 2 cases with the Ⅲ degree defect were reconstructed,and 1 cases with the Ⅳ degree,and 1 cases with the Ⅴ degree.In 8 cases（9 fingers） with the paratelum reconstruction,hallux donor site was performed the full-thickness skin transplantation,and the 2nd toe was sutured directly.In the other cases,free toe-nail flap of the 2nd toe were used.Results 12 fingers of the transplanted toes perfectly survived and 1 finger survived with the nail bed partial necrosis.All the patients were followed up for 28 months,and the sensory-motor function and appearance were restored satisfactorily.Functional evaluation：excellent in 3 fingers,good in 9,and fair in 1.The function and appearance of the foot donor site recovered well.Conclusions It is a effective way to reconstruct thumbs with combined free hallux toe-nail flap and bone and skin flap of the 2nd toe transplantation.

关 键 词：组织移植 趾 手指再造 拇指 

分 类 号：R658.22[医药卫生—外科学] R622.1[医药卫生—临床医学]