第二足趾节段桥接移植修复手指中间节段缺损  

Segmental second toe transfer for reconstruction of composite tissue defect of the digit

作　　者：刘刚义[1] 席志峰[1] 朱修文[1] 张志敏[1] 荣向科[1] 张洁[1] 王春旭[1] 苟军全[1] 

机构地区：[1]解放军第三医院石坝河分院手外科,宝鸡721006

出　　处：《中华手外科杂志》2013年第5期293-295,共3页Chinese Journal of Hand Surgery

摘　　要：目的总结采用第二足趾节段桥接移植修复手指指骨中间节段复合组织缺损的方法和疗效。方法2007年6月至2011年8月，对8例拇手指近或中节指骨中间节段复合组织缺损，采用第二足趾节段复合组织桥接移植修复。其中拇指3例，示指2例，中指2例，环指1例；采用带第二足趾近趾间关节节段复合组织4例，不含关节的节段复合组织4例。足部供区均采用截趾术。结果术中1例足趾在游离过程中发生血管痉挛，经局部对症处理后解除；术后8例复合组织及再植拇、手指均顺利存活，供、受区伤口均I期愈合。随访6～24个月，平均12个月，修复指体外形良好，恢复了屈、伸及抓捏功能。供足留有线条瘢痕，行走功能无影响。按中华医学会手外科学会断指再植评定标准评定：优2例，良5例，可1例；优良率为87．5％。结论采用第二足趾节段复合组织桥接移植修复手指中间节段组织缺损，虽然手术难度及风险较大，但修复后手指外形逼真，功能良好，是值得推广的一种术式。Objective To explore the surgical method and clinical effect of repairing composite tissue defects of the digit by transplanting a segment of the second toe. Methods Between June 2007 and August 2011, 8 cases of composite tissue defect of the digits including 3 cases of thumb defect, 2 cases of index finger defect, 2 cases of middle finger defect and 1 case of ring finger defect were treated in our hospital by transplanting a segment of the second toe. Transfer of a segment of the second toe containing the proximal interphalangeal joint was done in 4 cases, while the other 4 cases received a second toe segment without the interphalangeal joint. The donor sites were closed by amputating the remaining of the second toe in all the cases. Results Vasospasm occurred in one case during the operation and was relieved by local application of papaverine. All the transplants and reconstructed fingers and thumbs survived. The wounds at both recipient and donor sites healed primarily. The patients were follow-up for 6 to 24 months （mean, 12 months）. All repaired digits presented satisfactory appearance and recovered the function of flexion, extension, grip and pinch. The donor sites only had linear scars and no functional impairment was observed. According to the assessment criteria of replantation of amputated finger formnlated by the Chinese Medical Association, the results were excellent in 2 cases, good in 5 cases and moderate in 1 case with the excellent and good rate of 87.5%. Conclusion Although utilizing a segment of the second toe to repair composite tissue defects of the digits has some degree of difficulty and risk, the reconstructed fingers have good apoearance and function. This surgical method deserves general application.

关 键 词：指损伤 显微外科手术 组织移植 

分 类 号：R658.2[医药卫生—外科学]