足部瓦合皮瓣联合植骨再造不同程度拇指缺损  

Combined tiled flaps from foot with bone graft for reconstruction of thumb defects

作　　者：巨积辉[1] 李雷[1] 吴建龙[1] 李建宁[1] 蒋国栋[1] 侯瑞兴[1] 

机构地区：[1]苏州大学附属瑞华医院骨科,江苏省苏州市215104

出　　处：《中华显微外科杂志》2016年第1期33-36,共4页Chinese Journal of Microsurgery

基　　金：江苏省333高层次人才资助项目（BRA2014091）

摘　　要：目的探讨足部瓦合皮瓣联合植骨再造拇指的手术方法和临床疗效。方法自2008年1月-2013年12月。采用足部瓦合皮瓣联合髂骨植骨修复拇指不同程度缺损患者8例。急诊外伤所致拇指缺损伤4例，外伤后拇指陈旧性缺损4例，其中1例为双手电烧伤致双拇指缺损。拇指缺损分类Ⅰ类A区1例，Ⅰ类B区2例，Ⅱ类A区1例，Ⅱ类B区2例，Ⅲ类A区2例。其中躅甲瓣与第二趾胫侧皮瓣瓦合修复5例，躅甲瓣与足背动脉皮瓣串联瓦合修复3例。结果8例再造指均顺利成活。1例躅趾供区植皮部分坏死，经换药后愈合。随访6～72个月，修复后的拇指外形接近正常拇指，指甲生长良好，感觉恢复s：～s4。按照中华医学会拇、手指再造功能评价标准评定，属优者5例，良者3例。足部供区植皮愈合满意，无明显的瘢痕挛缩及破溃现象，不影响患者行走。结论利用足部瓦合皮瓣联合植骨再造拇指可以恢复拇指的良好外形，供足足趾个数不减少，是一种较好的方法。Objective To explore the operative technique and clinical outcomes of tiled flaps from foot with bone graft for reconstruction of thumb defects. Methods From January, 2008 to December, 2013, 8 cases of thumb defects with varying degrees were treated with tiled flaps from foot and iliac bone graft. Among them, 4 cases caused by emergency trauma, the other 4 cases was old defect after trauma, including 1 case of double thumb defect that caused by electrical burn. The thumb defects was caterorized as type Ⅰ A in 1 case, type ⅠB in 2 cases, type ⅡA in 1 case, type ⅡB in 2 cases and type ⅢA in 2 cases. Five cases in which were treated with free wrap-around flap from the ipsilateral big toe and tibial lateral-flap from the opposite second toe, 3 cases using free wrap-around flap with series connection of dorsal artery. Results All 8 reconstructed thumbs were survived. The wound healed primarily. In 1 case, the unhealed wound was healing after dressing where skin grafts in the donor sites of the foot were partial necrosis. Postoperative follow-up ranged from 6 to 72 months, the appearance of the thumb was satisfying when was compared with normal thumb. Thumb nail grew well, the blood supply was good, and sensory recovery from S2 to $4. According to the criteria issued by the Hand Surgery Society of Chinese Medical Association for functional assessment of reconstucted thumb and fingers, 5 were excellent and 3 were good. The donor site skin graft had no scar contraeture and no ulceration.There was no apparent impairment on the foot function. Conclusion Combined tiled flaps from foot and iliac bone graft for reconstruction of thumb is a good method, which can recover the appearance of thumb without sacrificing toes of the donor foot.

关 键 词：拇指 外科皮瓣 植骨 再造 

分 类 号：R658.2[医药卫生—外科学]