双侧(母)趾皮瓣瓦合修复拇指套脱伤可行性的初步探索  

The preliminary exploration of combined flaps from bilateral big toes in treating degloved injuries of the thumb

作　　者：廖观祥[1] 巨积辉[1] 刘新益[1] 周荣[1] 张广亮[1] 王天亮[1] 侯瑞兴[1] 

机构地区：[1]苏州大学附属瑞华医院手外科,江苏苏州215104

出　　处：《中国临床解剖学杂志》2013年第6期650-654,共5页Chinese Journal of Clinical Anatomy

摘　　要：目的探索游离母趾背侧趾甲皮瓣与对侧母趾腓侧皮瓣瓦合修复拇指套脱伤的可行性。方法对18具新鲜尸体标本的右拇指建立拇指套脱伤模型,将创面分为背侧和掌侧两部分,分别测量背、掌侧创面纵长及创面近端周径,记录测量数据,然后于尸体上模拟手术:背侧创面设计同侧母趾背侧趾甲皮瓣覆盖,掌侧创面设计对侧母趾腓侧皮瓣覆盖,两块皮瓣瓦合后修复整个套脱伤拇指创面。结果测得的36个拇指套脱伤模型的数据中,背侧创面纵长最大为6.2 cm,掌侧创面纵长最大为5.9 cm,创面近端周径最大为6.9 cm,均较文献报道两块皮瓣的最大可切取值小。18例模拟手术中,应用同侧母趾背侧趾甲皮瓣与对侧母趾腓侧皮瓣瓦合修复右手拇指套脱伤模型,一次性修复了创面、指腹及指甲,术后拇指指腹饱满,外形美观,与对侧正常拇指外形相似。结论母趾趾背侧趾甲皮瓣与母趾腓侧皮瓣均能够提供足够大皮瓣以覆盖背侧与掌侧创面,两块皮瓣瓦合修复拇指套脱伤的手术方式具有可行性。Objective To explore the feasibility of combined the free wrap-around flap of the ipsilateral big toe and the fibular flap of the contralateral big toe intreating degloved injuries of the thumb. Methods Eighteen right thumbs of fresh cadaver specimens were modeled to degloved injuries of thumbs. Wound surfaces of the thumb were divided into two parts ： the dorsal aspect and the plantar aspect, measurement of the vertical length of the dorsal and plantar aspects and proximal circumference of the wound surfaces was carried out, with obtained data recorded.Then dorsal wound of the models of degloved injuries of the thumbs was covered with wrap-around flaps of theipsilateral big toes and palm wound was covered by fibular flaps of the contralateral big toes. Results Among the measurement data of 36 models of degloved injuries of thethumbs,the largest vertical length of the dorsal aspect was 6.2cm, the plantar aspect 5.9cm and proximal circumference was 6.9 cm. All data above-mentioned were smaller than themaximum reported in the literature. Degloved juries of the right thumbs were repaired with combined free wrap-around flaps of the ipsilateral big toes and fibular flaps of thecontralateral big toes in 18 cases of surgical simulation,and the appearances were satisfactory and similar to the that of the contralateral normal thumbs. Conclusion Boththe wrap-around flapof the big toe and the fibular flap of the big toe can respectively provide a large enough flap to cover the wound surface of dorsal and volar surfaces ofthe thumb. The surgical approach of the combined free wrap-around flap of the ipsilateral big toe and the fibular flap of the contralateral big toe in treatment of deglovedjuries of the thumb is feasible.

关 键 词：拇指 趾 套脱伤 外科皮瓣 

分 类 号：R681.1[医药卫生—骨科学]