改良[足母]甲联合皮瓣修复拇指脱套伤的临床意义  

The clinical significance of modified combined wrap-around flap combined with tibial flap of the 2nd toe in repairing thumb degloving injuries

作　　者：张全荣[1] 芮永军[1] 施海峰[1] 陆征峰[1] 薛明宇[1] 魏苏明[1] 

机构地区：[1]无锡市手外科医院,江苏无锡214062

出　　处：《实用手外科杂志》2017年第3期275-277,280,共4页Journal of Practical Hand Surgery

摘　　要：目的 探讨改良[足母]甲瓣与第2趾胫侧联合皮瓣修复全拇指脱套伤临床意义.方法 1999年4月-2016年3月,釆用改良[足母]甲皮瓣修复拇指背侧和部分掌侧与第2趾胫侧皮瓣修复拇指掌侧软组织缺损,形成一个血管蒂的联合皮瓣修复拇指套状撕脱伤.并对足部皮瓣切取后的行走功能进行随访.结果临床应用11例拇指全部成活,受区伤口Ⅰ期愈合.术后随访8个月~3年.拇指指甲生长良好,外形接近正常,掌指关节屈伸活动和对指功能恢复正常,其中1例再造拇指冬天易生冻疮,拇指指腹感觉基本丧失,因拇指指神经未找到,仅接合足背皮神经与桡神经浅支者.其余病例感觉恢复.足部皮瓣切取后1例[足母]甲瓣供区植皮部分坏死,余植皮Ⅰ期愈合,供区行走良好,无疼痛,植皮处肤色深,关节活动无影响,随着足趾植皮处瘢痕的挛缩,植皮处范围的缩小,相应[足母]趾正常皮肤的生长,趾底负重区正常皮肤面积扩大,供区行走和活动良好.结论 改良[足母]甲皮瓣与第2趾胫侧联合皮瓣修复拇指套状撕脱伤,不但恢复了拇指的外形和功能,是治疗拇指脱套伤较好的术式;而且保留了[足母]趾胫侧的皮肤和趾底皮肤的负重区和一侧趾神经,随着[足母]趾皮肤的生长,使趾底负重区正常皮肤面积扩大,减少了单纯[足母]甲瓣移植后遗症.Objective To explore the clinical significance of modified combined wrap-around flap combined with tibial lflap of the 2nd toe in repairing thumb degloving injuries. Methods From April 1999 to March 2016, the applications of modified wrap-around flap combined with the 2nd toe tibial flap to repair soft tissue avulsion at thumbs were retrospectively analysed. Two kinds of flaps formed a joint flap by sharing one vascular pedicle. Walking function of feet was followed up after flap cutting out. Results All 11 cases of joint flaps transplanted to repair the thumb degloving injuries entirely survived. All wounds healing were first intention. After followed up for 8 to 36 months, the thumb nails grew well, the appearance was close to normal, the metacarpophalangeal joint function and digital opposition function restored. 1 case was easy to get frostbite and almost lost sensory function of thumb pulp. As its digital nerve was elusive, we just anastomosed dorsal cutaneous nerve of foot nerve and superficial branch of radial nerve. 1 case had skin necrosis donor site after flap cutting, the others survived by first intention. The feeling, joint motion and walking function of feet recovered well. Conclusion Using modified wrap-around flap combined with tibital flap of the 2nd toe to repair thumb degloving injuries can restore the appearance and function of thumb. In addition, it restores tibital skin of hallex and loading area, partial nerve of the toe. With the growing of hallex normal skin, the skin weight-beating area expands. It can decrease the complication probolility caused by simply wrap-around flap transplantation.

关 键 词：拇指 趾 组织移植 显微外科手术 

分 类 号：R658.1[医药卫生—外科学]