拇指全形再造的临床体会  

Clinical application of reconstructive surgical procedures of thumb

作　　者：刘刚义[1] 程永冲[1] 朱修文[1] 王春旭[1] 苟军全[1] 张志敏[1] 荣向科[1] 张洁[1] 王芳[1] 

机构地区：[1]解放军第三医院石坝河分院手外科,陕西省宝鸡市721006

出　　处：《中华显微外科杂志》2013年第3期241-244,共4页Chinese Journal of Microsurgery

摘　　要：目的总结拇指全形再造的手术方法及临床疗效。方法自2010年3月至2012年5月，对14例拇指Ⅲ-Ⅳ度缺损，根据受区需要设计切取同一血管蒂的躅趾甲皮瓣和第2足趾骨皮瓣，然后以足母趾甲皮瓣包裹第2足趾骨皮瓣移至受区，修复重建拇指外形及功能。躅趾甲皮瓣供区用第2趾甲皮瓣修复。结果14例再造拇指全部成活。2例术中发生血管痉挛，以利多卡因滴注血管外膜、温热盐水局部热敷后解除，其余12例再造拇指均顺利成活。14例均获随访6-18个月（平均12个月），除1例指甲欠平整外，其余再造指体均恢复良好；外形接近健侧指体，恢复对指及屈伸功能，两点辨别觉6-8mm。参照中华医学会手外科学会上肢部分功能评定试用标准：优7例，良6例，可1例；优良率为92．9％。结论采用同一血管蒂的腮趾甲皮瓣联合第2足趾骨皮瓣组合移植修复重建拇指外形及功能，虽手术难度及风险大，但修复后外形及功能良好，是一种理想的术式，值得推广。Objective To summarize the surgical methods and clinical efficacy of the thumb full- shaped reconstruction. Methods Fourteen cases with Ⅲ and Ⅳ degree thumb defect were underwent the thumb full-shaped reconstruction from March 2010 to May 2012. According to the region need, cutting the hallux toenail flap and second toe bone flap of the same vascular pedicle, and then the hallux toenail flaps wrapped second toe bone flap was transferred to reconstruction of thumb shape and function. Hallux toenail flap donor site was repaires with second toenail flap. Results Thumbs of 14 cases were all survived. Vasospasm were occurred in 2 cases at operation and were relieved by lidocaine dropped outside vascular and local fomentation by warm saline. The remaining 12 cases of thumb reconstruction survived successfully. Fourteen patients were followed up for 6-18 months（ 12 months on average）. Except for 1 case of nail irregularity, the remaining reconstructive thumb recovered well. The appearance was the same as contralateral one. The flexion and extension function were recovered. The two-point discrimination of the finger pulps was ranged from 6mm to 8 mm. According to the trial standard of upper limb part of functional assessment of the Hand Surgery Branch of Chinese Medical Association, among the 14 cases, there were excellent in 7, good in 6, and fair in 1, with an excellent and good rate of 92. 9%. Conclusion Hallux nail flap combined with second toe bone flap of the same vascular pediele was transferred to repair and reconstruct thumb of appearance and function. Although the difficulty and risk of operation is large, after reconstruction the appearance and function of thumb is good. This technique is an ideal procedure and worthy of promotion.

关 键 词：拇指 躅趾甲皮瓣 第2足趾骨皮瓣 全形再造 显微外科 

分 类 号：R65[医药卫生—外科学]