游离全厚皮肤移植重建甲床完全缺损的临床研究  

Clinical study of full-thickness skin graft for reconstruction of completely defect nail unit

作　　者：李文军[1] 李淳[1] 朱瑾[1] 田光磊[1] 陈山林[1] 田文[1] 

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《北京大学学报（医学版）》2012年第6期860-865,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨一种重建各种原因导致甲床完全缺损的手术方法,并分析游离全厚皮肤移植修复甲床缺损的效果。方法:对2010年4月至2012年3月,北京积水潭医院手外科采用游离全厚皮肤移植重建甲床完全缺损7例患者进行回顾性分析。男性2例,女性5例,年龄7～70岁,平均51.9岁。术前诊断为感染1例,鳞状细胞癌1例,甲下色素沉着2例,交界痣1例,恶性黑色素瘤2例;拇指2例,中指3例,示指2例。甲床缺损范围在1.5 cm×2cm至2.5 cm×3.5 cm,移植皮肤取自上臂内侧3例,腹股沟部3例,前臂肘窝部1例。结果:所有患者均得到了随访,平均随访时间为10个月,所有游离移植皮肤全部成活,但初期颜色呈淡紫色,并伴有表浅水泡形成。成活后的皮肤平整,与末节指骨骨面贴敷紧密,无表皮包涵囊肿及残留指甲形成,皮肤供区无并发症出现。所有患者均对手指外形及功能满意,没有意愿要求再造指甲。结论:采用游离全厚皮肤移植重建甲床完全缺损,方法简单、安全、有效,手指外形及功能满意,且供区无明显并发症,尤其适用于中老年患者。Objective：To explore a reconstruction method for complete nail bed defect caused by various kinds of reasons and to retrospectively analyze the effect of application of free full-thickness skin graft for the whole nail unit repair.Methods：Between Apr.2010 and Mar.2012,the method of free full-thickness skin graft was done for reconstruction of the completely nail unit defect in seven cases.There were 2 male and 5 female patients;the mean age of these patients at the time of surgery was 51.9 years（range：7 to 70 years）.The pre-operative diagnoses included two cases of malignant melanoma,one of chronic infection,one of squamous cell carcinoma,two of subungual pigmentation and one of junctional nevus.There were 2 thumb lesions,3 middle and 2 index finger lesions.Nail unit defect was in the range of 1.5 cm × 2 cm to 2.5 cm × 3.5 cm and full thickness skin graft was harvested from the same medial side of upper arm（3 cases）,forearm cubital fossa（1 case） and contralateral side of groin region（3 cases）.Results：All the patients were followed with an average follow-up time being 10 months.All the free skin graft taken was achieved with 100% in all the 7 cases,even in those patients whose partial cortical bone had been curetted.The skin graft was often bluish initially,and superficial blisters were always noticed within 1.5 months postoperatively and the survival skin graft was smooth eventually,and skin graft was adhered to the underlying bone tightly.There was no epidermal inclusion cyst and no residual nail formation.The skin donor sites were without complications.Aesthetic appearance was assessed by the surgeons and found no unacceptable for their patients.And all the patients were satisfied with the cosmetic appearance and active range of motion of their involved fingers,who did not express a desire to undergo any further of nail reconstruction.Conclusion：Free full-thickness skin grafting for reconstruction of the complete nail unit defect is a simple,safe and effective procedure which provide

关 键 词：皮肤移植 修复外科手术 指甲疾病 

分 类 号：R758.72[医药卫生—皮肤病学与性病学]