[足母]甲皮瓣联合足背皮瓣移植并髂骨植骨拇指再造5例  

Thumb reconstruction using wrap-around flap from the big toe, dorsalis pedis flap and iliac crest bone graft： a report of 5 cases

作　　者：李雷[1] 巨积辉[1] 崔龙杰[1] 邓伟[1] 蒋国栋[1] 侯瑞兴[1] 

机构地区：[1]苏州大学附属瑞华医院手外科,苏州215104

出　　处：《中华手外科杂志》2016年第5期325-328,共4页Chinese Journal of Hand Surgery

基　　金：江苏省自然科学基金项目（BK20151203）

摘　　要：目的探讨[足母]甲皮瓣联合足背皮瓣移植并髂骨植骨再造全拇指缺损的手术方法和临床疗效。方法对5例拇指全指缺损的患者，采用[足母]甲皮瓣联合足背皮瓣移植并髂骨植骨全指再造。骨缺损均采用不带血供的髂骨条移植修复。结果术后患者伤口均Ⅰ期愈合，5例再造指均顺利存活。1例[足母]趾供区植皮部分坏死，经换药后愈合。术后8～12周摄X线片，移植骨与拇指骨质临床愈合取出内固定。随访8—38个月，修复后的拇指外形接近正常拇指，指甲生长良好，血供好，再造指体指背感觉恢复至S2-S3指腹恢复至S2～S4。2例掌指关节融合者无关节活动度。5例均可以完成对指、对掌功能。随访期内未出现骨不愈合及移植骨吸收的现象。按照中华医学会拇、手指再造功能评价标准评定，优4例，良1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。髂部供区线状瘢痕愈合，无触痛等不适感。患者自我感觉均满意。结论利用跨甲皮瓣联合足背皮瓣移植并髂骨植骨全指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 surgical techniques and clinical outcomes of combined transfer of big toe wrap-around flap and dorsalis pedis flap with iliac bone graft for reconstruction of the whole thumb. Methods Five patients with complete thumb defect underwent combined transfer of the wrap-around flap from the big toe and the dorsalis pedis flap. The bone defect was repaired by non-vascularized iliac bone graft. Results Primary wound healing was achieved in all the patients. The reconstructed thumbs all survived uneventfully. Partial necrosis of the skin graft at the big toe donor site occurred in one case which was healed after dressing change. X-ray examination 8 to 12 weeks after the surgery revealed bone union botween the grafted bone and the remaining thumb phalanx, when the internal fixation was removed. The patients were follow-up for 8 to 38 months. The appearance of the reconstructed thumb was comparable to a normal one. The thumbs had good perfusion and proper nail growth. Sensory recovery reached S2 toS3 on the dorsum of the thumb and S2 to S4 on the pulp. No motion was observed in 2 cases with metaearpophalangeal joint fusion. Opposition with the fingers and palmar opposition could be accomplished in all 5 cases. Nonunion and resorption of the grafted bone did not occur. According to the functional evaluation criteria for thumb and finger reconstruction issued by the Chinese Medical Association, the results were excellent in 4 cases and good in 1 case. Skin graft at the donor sites healed well without ulceration or scar contracture. Walking was not impaired. Linear scat＂ occurred in the iliac donor sites without discomfort. The patients were satisfied with the results. Conclusion Combined transfer of big toe wrap-around flap and dorsalis pedis flap with iliac bone graft is an ideal procedure for reconstruction of the whole thumb. It restores the proper appearance of the thumb without sacrificing any toes.

关 键 词：拇指 外科皮瓣 缺损 植骨 

分 类 号：R658.2[医药卫生—外科学]