一期利用足二趾及组合皮瓣行拇指再造  

Stage-I Thumb Reconstruction with the Second Toe and Combined Skin Flap

作　　者：陈少华[1] 陈昌伟[1] 张发贵[1] 戴赛君[1] 

机构地区：[1]解放军第113医院骨三科,浙江宁波315040

出　　处：《临床军医杂志》2012年第6期1349-1351,共3页Clinical Journal of Medical Officers

摘　　要：目的介绍游离第二足趾、拇趾腓侧皮瓣及足背皮瓣一期行拇指再造术式。方法切取第二足趾的同时游离并切取"猫耳状"组织瓣的足背皮瓣及拇趾腓侧皮瓣,将拇趾腓侧皮瓣嵌入第二足趾跖侧,足背皮瓣上的"猫耳状"瓣嵌入第二足趾两侧的侧方创面,足背皮瓣覆盖第一掌背或大鱼际皮肤缺损处。结果 15例再造拇指均成活,嵌入的趾腓侧皮瓣及足背皮瓣也全部成活。术后随访6个月～3年,再造拇指外形较传统的第二足趾移植有了不同程度的改善。结论 (1)拇趾腓侧皮瓣嵌入第二足趾,能较好地重塑第二足趾外形,使之更接近正常的手指。(2)足背皮瓣能修复拇指皮肤缺损,"猫耳状"皮瓣能更好地覆盖再造指创面,再造拇指外形更佳。(3)一期行拇指再造不仅能减少患者经济及精神上负担还能给术者带来解剖上的方便。Objective To introduce Stage-I thumb reconstruction by transplanting the second toe,fabular hallux flap and dorsalis pedis flap. Methods Dorsalis pedis flap of ＂cat＇s ear shaped＂ tissue flap and fabular hallux flap were cut and transplanted while the second toe was cut.Fabular hallux flap was embedded into the plantar side of the second toe and ＂cat＇s ear shaped＂ flap on dorsalis pedis flap was implanted into the wound on both sides of the second toe,while dorsalis pedis flap covered the impaired part of the first dorsal metacarpal or thenar skin. Results 15 reconstructed thumbs,implanted fabular hallux flap and dorsalis pedis flap survived.Through follow-up visits for six months to 3 years after operation,the appearance of reconstructed thumbs were improved to different extents compared with relatively traditionally transplanted second toes. Conclusion（1） the appearance of the second toe can be better reshaped to be more similar to normal fingers once fabular hallux flap is implanted.（2） Impaired part of thumb skin can be restored by dorsalis pedis flap and the plantar side of reconstructed fingers can be better covered by ＂cat＇s ear shaped＂ flap,while thumbs are reconstructed with better looks.（3） Stage-I thumb reconstruction can not only ease patients＇ economic and mental burdens,but also makes it convenient for operators to dissect.

关 键 词：第二足趾移植 拇指损伤 外科皮瓣 一期手术 拇指再造 

分 类 号：R622[医药卫生—整形外科]