游离第二足趾背甲皮瓣联合趾腓侧皮瓣游离移植修复单指脱套伤  

Combined transfer of the free second toe dorsal wrap around flap and fibula side flap of great toe to repair degloving injury of the single finger

作　　者：王斌[1] 蒋文平[1] 李文龙 张剑锋[1] 李春江[1] 王辉[1] 王鹏飞[1] 

机构地区：[1]唐山市第二医院(河北联合大学附属骨科医院),河北省唐山市063000 [2]解放军第二五六医院

出　　处：《中华显微外科杂志》2012年第6期444-446,I0002,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨单指脱套伤修复的新方法。方法2007年8月至2010年6月，应用游离第二足趾背甲皮瓣联合扩大的（母）趾腓侧皮瓣修复单指脱套伤11例，其中示指6例，中指2例，环指3例。Ⅰ型脱套伤4例,Ⅱ型脱套伤7例。均急诊清创VSD封闭负压吸引，于伤后3—5d行手术修复。（母）趾腓侧皮瓣内和第二足趾背甲皮瓣内的趾底神经与受区残端的指神经进行吻接。供区游离植皮。结果11例皮瓣全部成活。术后2例第二趾背远端植皮部分坏死，后经换药愈合，1例指骨穿过存活的皮肤外露，手术截除部分外露指骨后伤15愈合。11例均获得完整随访，随访3个月～3年，皮瓣颜色正常，质地柔软，外观不臃肿、接近健侧指。11例修复脱套指原第二趾背甲皮瓣感觉恢复达S3，原（母）趾腓侧皮瓣修复的指腹饱满．两点辨别觉为6～9mm，平均7．0mm。手指伸屈功能按手指总主动活动度（TAM）评分法评定，优9指,良2例。结论游离第二足趾背甲皮瓣联合扩大的（母）趾腓侧皮瓣是修复单指脱套伤的有效方法。Objective To provide the new method for repairing degloving injury of the single finger. Methods From August 2007 to June 2010, eleven patients were repaired with the second free toe dorsal wrap around flap and fibula side flap of great toe. Patients including 9 men and 2 women. The mean age were 31 years （17-49 years）. The finger including 6 index fingers, two middle fingers and 3 ring fingers, in which 4 patients were type Ⅰ and 7 patients were type Ⅱ. All of them were emergency debridement VSD closed negative pressure attraction, surgical repair in 3-5 days after injury. The plantar digital nerve in the second free toe dorsal wrap around flap and fibula side flap of great toe with the digital nerve of the stump by end-to-end nerve anastomosis. The donor sites were covered with a free flap. Results All of 11 flaps sur- vived, but 2 cases developed partial native second toe skin grafting necrosis, by dressing healed, one case of phalanges exposed through survival skin, the part of the exposed phalanx healed after surgical cut. All the 11 patients were followed up from 3 monthes to 3 years. The flaps survived completely with satisfactory cosmetic results and good sensibility. The sensation recovery was reached above S3. The great toe fibular flap for repair of finger pulp full, two-point discrimination was 6-9 mm, the mean was 7.0 mm. Finger flexion function by finger total activity （TAM） score assessment, excellent 9 cases, good 2 cases. Conclusion Transfer of the second free toe dorsal wrap around flap and fibula side flap of great toe to repair degloving injury of the sin- gle finger is an ideal method of treatment.

关 键 词：第二足趾背甲皮瓣 蹿趾腓侧皮瓣 手指 脱套伤 

分 类 号：R658.2[医药卫生—外科学]