第二趾背甲皮瓣联合中环指岛状皮瓣修复拇指脱套伤的临床研究  

RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP

作　　者：王斌[1] 贾松[1] 卢爱东[2] 郝睿峥[1] 霍永鑫[1] 费小轩[1] 庞海涛[1] 

机构地区：[1]唐山市第二医院(河北联合大学附属骨科医院)手外一科,河北唐山063000 [2]开滦总医院眼科

出　　处：《中国修复重建外科杂志》2016年第11期1383-1386,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨第2趾背甲皮瓣联合中环指岛状皮瓣修复拇指脱套伤的疗效。方法 2009年8月-2013年6月,采用第2趾背甲皮瓣联合中环指岛状皮瓣修复6例机器绞伤导致的拇指脱套伤。男4例,女2例;年龄19~44岁,平均32岁。左手2例,右手4例。Ⅱ型脱套伤5例、Ⅲ型1例。创面范围5.5 cm×2.5 cm^6.5 cm×5.0 cm。急诊清创后,5例行封闭式负压引流3~5 d后行皮瓣修复;1例行腹部包埋,14 d后行皮瓣修复。第2趾背甲皮瓣切取范围为2.5 cm×2.2 cm^4.2 cm×3.0 cm,中环指岛状皮瓣为2.0 cm×1.5 cm^3.5 cm×2.8 cm。第2趾背甲皮瓣内的趾底神经与受区残端指神经吻接5例,未吻合1例。6例均截除部分末节指骨。供区游离植皮修复。结果术后患者第2趾背甲皮瓣及中环指岛状皮瓣均顺利成活;供区植皮均顺利成活,切口Ⅰ期愈合。中环指岛状皮瓣异位感觉3例。6例均获随访,随访时间6个月~3年,平均23个月。皮瓣颜色正常、质地柔软;手指外观不臃肿,与健侧拇指相似,但指甲均较健侧小。拇指背侧感觉恢复达S 3;拇指指腹饱满,两点辨别觉达4~7 mm,平均6 mm;手指伸屈功能按手指总主动活动度(TAM)评分法评定,优5例、良1例。结论第2趾背甲皮瓣联合中环指岛状皮瓣修复拇指脱套伤可获得满意手指外形及功能。ObjectiveTo investigate the effectiveness of free second toe dorsal flap combined with middle or ring finger island flap for repairing degloved thumbs. MethodsBetween August 2009 and June 2013, 6 patients with degloving injury of the thumb were treated using free second toe dorsal flap combined with middle or ring finger island flap. There were 4 males and 2 females, aged 19-44 years （mean, 32 years）. The left thumb was involved in 2 cases and the right thumb in 4 cases, including 5 cases of type II and 1 case of type III degloving injury. The size of wound was 5.5 cm×2.5 cm to 6.5 cm×5.0 cm. After emergency debridemented, 5 patients underwent vacuum sealing drainage and surgical repair after 3-5 days; 1 patient underwent abdominal embedding and repair after 14 days. The size of second toe dorsal flap ranged from 2.5 cm×2.2 cm to 4.2 cm×3.0 cm, and the size of middle or ring finger island flap ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm. Neurorrhaphy was performed between the plantar digital nerve of the second toe and the proper digital nerve at the recipient site in 5 cases, and no nerve anastomose in 1 case. All the distal phalanxes were partially excised. The donor sites were covered with free skin grafts. ResultsAll of the flaps survived completely and incision healed by first intention. Three patients had alloesthesia of the middle or ring finger island flaps. All of the 6 patients were followed up from 6 months to 3 years （mean, 23 months）. The flaps had good color and soft texture, and the finger had satisfactory appearance, but the fingernails were smaller than that of normal side. The sensation of the dorsum of the second toe reached S3, and the mean two-point discrimination of the pulp was 6 mm （range, 4-7 mm）. According to total active movement （TAM） system, the function of the thumbs was excellent in 5 cases and good in 1 case. ConclusionA combination of free second toe dorsal flap and middle or ring finger island flap is a useful and reliable technique for reconstruction of a de

关 键 词：第2趾甲瓣 中环指岛状皮瓣 拇指 脱套伤 

分 类 号：R658.2[医药卫生—外科学]