接合神经的甲皮瓣修复拇指皮肤软组织缺损  

Toe nail flap with nerve anastomoses for repairing thumb skin soft tissue defect

作　　者：张荣峰[1] 孙新君[1] 江海廷[1] 张福田[1] 

机构地区：[1]中国人民解放军第89医院骨科,山东潍坊261000

出　　处：《实用手外科杂志》2016年第3期255-257,共3页Journal of Practical Hand Surgery

摘　　要：目的：探讨采用接合神经的甲皮瓣修复拇指甲床及皮肤软组织缺损的临床疗效。方法2006年1月-2014年1月，急诊应用甲皮瓣移植修复伴有甲床缺损的拇指皮肤软组织损伤32例，均将趾底神经-指固有神经接合，腓神经皮支与桡神经浅支接合，供区直接缝合。结果术后32例甲皮瓣全部成活，随访12~36个月，拇指外观良好，指甲生长良好，皮瓣颜色与周围皮肤近似；均有良好的感觉和运动功能，指腹两点辨别觉为4~8 mm。参照中华医学会手外科分会拇、手指再造功能评定试用标准评定，优25例，良6例，可1例，无差的病例，优良率96.9%。结论采用接合趾底神经-指固有神经、腓神经皮支与桡神经浅支的方法，急诊游离甲皮瓣移植修复合并甲床缺损的拇指损伤，术后拇指外形及功能比较满意，神经功能恢复良好。Objective To investigate the clinical outcomes and experience of using thumb nail flaps with nerve anastomoses to repair thumb nail bed and skin soft tissue defect. Methods From January 2006 to January 2014, 32 cases were using emergency thumb nail flap transplantation to repair thumb skin soft tissue injury with nail bed defects. All the cases were treated with toe bottom nerve and finger intrinsic nerve anastomoses, cutaneous branch of peroneal nerve and superfical branch of radial nerve anastomoses, and the donor sites were directly sutured. Results All thumb nail flaps in 32 cases survived after surgery. After 12~36 months of follow up, the thumbs were in good shape, the nails grew well, and the color of flaps was close with the surrounding skin; all had good sensory and motor function, and two-point discrimination of finger pulps was 4~8 mm. According to Chinese Medical Association of Hand Surgery branch of replantation and reconstruction of function evaluation test standard, 25 cases were excellent, 6 cases were good, 1 case was acceptable, and no bad cases occured, and the excellent and good rate was 96.9%. Conclusion Using the method of toe bottom nerve and finger intrinsic nerve anastomoses, cutaneous branch of peroneal nerve and superfical branch of radial nerve anastomoses, emergency free hallux toe nail flap to repair thumb injury with nail bed defects, the appearance and functions of thumbs after surgery are satisfactory, and the nerve function recovers well.

关 键 词：拇指外伤 甲皮瓣 组织移植 显微外科技术 

分 类 号：R622.1[医药卫生—整形外科]