第二足趾携带跨足背足底内侧皮瓣再造拇指及皮肤缺损修复  

Repaire of thumb and cutaneous deficiency with the second toe taking along dorsum of foot skin flap and footplate skin flap

作　　者：刘勇[1] 张成进[1] 付兴茂[1] 王剑利[1] 王成琪[1] 隋志强[1] 张雪涛[1] 王蕾[1] 

机构地区：[1]解放军第89医院全军创伤骨科研究所,山东潍坊261021

出　　处：《临床骨科杂志》2015年第4期469-471,474,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨利用第二足趾携带跨足背足底内侧皮瓣一期再造拇指及皮肤缺损修复的临床效果。方法对足背皮瓣和足底内侧2个皮瓣进行解剖学研究,并设计以足背血管为蒂的携带跨足背与足底内侧2个皮瓣供区的跨供区皮瓣及第二足趾移植术式。一期完成6例严重拇指缺失伴大面积皮肤缺损(8 cm×10 cm^13cm×17 cm)的再造及修复。结果 6例重建拇指全部存活。患者均获随访,时间3~12个月。拇指外形及功能恢复良好,按手指功能损害程度的综合评定,全部的手功能由平均25%上升到术后的平均70%,功能平均增加45%。按照中华医学会手外科学会拇手指再造功能评定标准,优3例,良2例,差1例。结论足背皮瓣与足底内侧皮瓣存在丰富的交通供血区,以足背血管为蒂携带第二足趾及跨供血区皮瓣血供丰富,利用第二足趾携带跨足背足底内侧皮瓣一期再造拇指伴皮肤缺损是一种较好的方法。Objective To investigate the clinical effect on repaire of thumb and cutaneous deficiency with the second toe taking along dorsum of foot skin flap and footplate skin flap. Methods According to anatomy research of dorsum of foot skin flap and footplate skin flap,the grafting of phalanges of foot which including the two skin flap and the sec-ond toe cascaded with dorsal blood vessel of foot was designed to repair thumb and cutaneous deficiency. 6 cases with severe thumb and cutaneous deficiency（8 cm × 10 cm∽13 cm × 17 cm）were used by this method. Results 6 cases of thumb reconstruction was operated by this method successfully. All cases were followed up for 3∽12 months after operation, good shape and functional rehabilitation was present. The hand function was increased from average 25% to 70%（ average 45%） ,which was evaluated by hand functional lesion evaluation criterion. The cases were evaluated by thumb and finger reconstruction functional lesion evaluation criterion of hand surgery institute of Chinese Medical As-sociation,3 cases were excellent,2 good and 1 poor. Conclusions There is many blood vessel communicating bran-ches in the area of dorsum of foot skin flap and footplate skin flap. Blood supply is plentiful in the complex tissue cas-caded the two skin flap and the second toe cascaded with dorsal blood vessel of foot. Thumb reconstruction using the second toe taking along dorsum of foot skin flap and footplate skin flap is a good method.

关 键 词：皮瓣移植术 拇指再造 跨供区 

分 类 号：R622.12[医药卫生—整形外科] R658.1[医药卫生—外科学]