手指Ⅰ-Ⅲ度缺损的全形再造  

Full reconstruction of I to Ⅲ.degree finger defect

作　　者：王增涛[1] 孙文海[1] 仇申强[1] 朱磊[1] 刘志波[1] 官士兵[1] 胡勇[1] 

机构地区：[1]山东大学附属省立医院手足外科,济南250021

出　　处：《中华显微外科杂志》2011年第4期266-268,353,共4页Chinese Journal of Microsurgery

摘　　要：目的介绍手指Ⅰ至Ⅲ度缺损全形再造的方法。方法从1998年12月至2010年12月，对手指Ⅰ度和Ⅱ度缺损，根据受区需要设计切取躅趾腓侧部分趾甲、趾甲下趾骨的腓背侧部分以及皮肤，形成趾甲、骨、皮肤复合组织瓣。皮瓣卷成圆筒状包裹趾骨形成新的手指远段，像断指再植一样，将再造的手指远段移植到手指残端形成新的手指。对于手指Ⅲ度缺损．皮肤仍根据残指需要的大小在躅趾上设计，但趾骨因只能在躅长伸肌腱止点以远切取，且只切取腓背侧部分，长度有限，有些病例不能达到原缺损的长度时，则取适当大小形状的髂骨与取下的趾骨串在一起，移植到手指残端再造出新的手指。部分手指Ⅲ度缺损病例。同时切取第2足趾趾间关节移植再造手指远侧指间关节。第2足趾骨缺损用髂骨充填以保持第2趾的外形。躅趾创面采用局部皮瓣移位修复或游离皮瓣移植修复。结果Ⅰ度缺损118例126指，Ⅲ度缺损187例201指，Ⅲ度缺损90例111指全部成活，外形接近正常手指。其中150指进行了1～5年的随访，手指总活动度全部达到180°以上。趾间关节移植再造远指间关节的病例术后再造手指远指间关节活动度为15°-40°。供区拇趾术后长度与周径接近正常，虽然趾甲大部分缺失，但供足行走功能全部正常。结论跨趾腓背侧复合组织瓣移植或躅趾腓背侧复合组织瓣加髂骨串联移植再造手指I至Ⅲ度缺损，再造手指功能外形俱佳，供区皮瓣修复后躅趾形状与功能所受影响小。Objective To introduce the new method of full reconstruction for I to Ⅲ-degree finger defect. Methods For reconstruction of I to Ⅲ-degree finger defect, the surgery procedure was as follows： Harvest part of nail, skin and dorsal part of distal phalanx from hallux to form a composite flap, and then the flap was transplanted to the finger stump to reconstruct the defect part of the finger. The design of the composite flap was according to the recipient part. For reconstruction of III-degree finger defect, the skin in- cluded in the flap could be designed according to the recipient part, but the bone can only be harvested from the fibulodoral part of the hallux and far from the insertion of the extensor hallucis longus tendon, which means the length was limited. If the bone length was not enough, one bone mass with appropriate size and shape was harvested from the iliac bone and connected with the bone of the composite flap. Some cases of Ⅲ- degree finger defect were reconstructed by harvesting interphalangeal joints from the second toes to reconstruct distal interphalangeal joints（DIP）. The bone defect was reconstituted by bone mass from the iliac bone to con- serve the contour of the second toe. The hallux wound was covered by a local flap or free flap transplantation. Results One hundred and eighteen cases （126 fingers） of I-degree defect, one hundred and eighty-seven cases （201 fingers） of II-degree defect and 90 cases （111 fingers） of III-degree finger defect were applied full reconstruction. All the reconstructed fingers survived completely and the configurations were similar to re- al fingers. Followed up our work on 150 fingers from a number of patients, between 1 and 11 years after the original surgery. Total ranges of motion of the reconstructed fingers got to over 180°. The reconstructed DIP joints had the range of motion of 15°-40°. The donor halluxes and toes were conserved with the normal length, relatively primary appearance and full function. Conclusion Full reconstruction

关 键 词：指 再造 移植 组织瓣 显微外科 

分 类 号：R658.1[医药卫生—外科学]