足趾移植联合下腹部筋膜穿支皮瓣在手拇指再造中的应用  

Application of toe transplantation combinw with skin flaps of the perforating branch of lower abdominal fascia in thumb reconstruction

作　　者：金光哲[1] 巨积辉[1] 李雷[1] 刘跃飞[1] 魏诚[1] 李建宁[1] 刘新益[1] 赵强[1] 邹国平[1] 侯瑞兴[1] 

机构地区：[1]苏州大学附属瑞华医院手外科,江苏苏州215104

出　　处：《中国美容医学》2010年第11期1596-1599,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:报道下腹部筋膜穿支皮瓣在伴有手掌、手背及虎口皮肤软组织缺损的手拇指再造中的应用疗效。方法:对6例伴有手掌、手背及虎口皮肤软组织缺损的手拇指毁损患者,在常规实施足第二趾移植再造的基础上采用游离以腹壁浅动脉或旋髂浅动脉为蒂的下腹部筋膜穿支皮瓣修复创面。结果:术后6例皮瓣及再造指体全部成活,经4～12个月随访,皮瓣质地外形优良,再造手指功能恢复满意,可完成对指、对掌等动作,按中华医学会手外科学会手指再植与再造功能评定标准评定,4例为优,2例为良,优良率100%。1例皮瓣外形稍臃肿经二次修薄后恢复满意。供区伤口均一期愈合,遗留线状瘢痕,外形较满意。2例经12个月随访,皮瓣恢复保护性感觉,无色素沉着现象。结论:对伴有手掌、手背及虎口皮肤软组织缺损的手拇指再造,应用游离下腹部筋膜穿支皮瓣联合足第二趾进行修复,设计灵活,修复后外形恢复好,且对供区损伤小,是修复此类损伤的理想选择。Objective To report the clinical efficacy of skin flaps of the perforating branch of lower abdominal fascia in reconstructing thumbs defects including defected palmar,dorsal,and hukou soft tissues.Methods 6 patients with thumb defects（including palmar,dorsal and hukou soft tissue defects） were recruited.After conventional reconstruction using second-toe transplantation,skin flaps of the perforating branch of lower abdominal fascia,pedicled with the superficial epigastric artery or superficial iliac circumflex artery,were used to repair the defects.Results After surgery,all 6 skin flaps and reconstructed thumbs survived.Followed-up for 4 to 12 months revealed favorable appearance and texture of the skin graft,recovery of reconstructed functions to perform finger-to-finger and palm-to-palm activities.According to the evaluation standards for finger replantation and functional reconstruction by the Hand Surgery Institute of Chinese Medical Association,the excellence rate was 100% with 4 cases of excellence and 2 cases of satisfaction.One case manifested slightly bloated flap,and was successfully re-trimmed.Primarily wound healing was achieved in each donor area,leaving only linear scars with satisfactory appearance.12-month follow up revealed that two cases had restored protective feelings of the skin flaps without pigmentation.Conclusion The application skin flaps of the perforating branch of lower abdominal fascia in conjunction with second-toe reconstruction is a flexible and ideal method for repairing thumbs defects complicated with defected palmar,dorsal,and hukou soft tissues,hardly causing damage to the donor area.

关 键 词：下腹部 穿支皮瓣 再造 手部损伤 

分 类 号：R622[医药卫生—整形外科]