复杂拇指缺损合并桡侧大面积皮肤缺损的重建与修复  

Repairment and reconstruction of complex thumb defect combined radial side large skin defect by tissue flap transplantation

作　　者：余志平 于晓峰 丛海波 于长征 丁英杰 王晓科 王志浩 邢国飞 毕建飞 孙炳龙 YU Zhiping YU Xiaofeng CONG Haibo et al(Department of Microsurgery, The Center Hospital of Weihai City, Weihai, Shandong, 264400, Chin)

机构地区：[1]威海市中心医院显微外科,山东威海264400

出　　处：《实用手外科杂志》2017年第2期233-235,共3页Journal of Practical Hand Surgery

基　　金：泰山学者工程专项经费资助项目（项目编号：ts2015UUO）;山东省医药卫生科技发展计划（2015WS0087）

摘　　要：目的 探讨组合组织移植修复重建复杂拇指缺损合并桡侧大面积皮肤缺损的临床疗效.方法 2010年8月-2014年10月,对手桡侧大面积皮肤缺损合并拇指Ⅳ度缺损及拇指Ⅴ度缺损（大鱼际肌完整）,采用股前外侧皮瓣组合第2足趾移植重建17例.手桡侧大面积皮肤缺损且大鱼际缺损合并拇指Ⅴ度、 Ⅵ度缺损者采用皮瓣组合携带踇、 趾短伸肌的第2足趾移植修复皮肤缺损及再造拇指4例.结果 术后随访2年以上,再造手指及移植皮瓣均恢复较好的感觉功能,两点辨别觉3-7 mm.再造拇指与手指对捏距离小于1 cm 7例,小于2 cm 12例,小于3 cm 2例;拇对掌功能Ⅲ度16例,Ⅱ度4例,Ⅰ度1例.采用Kawabate评分评价手部功能,优11例,良9例,可1例,优良率达95.2%.再造拇指BMRC感觉功能评分,改善率达95.2%.结论 复杂拇指缺损合并桡侧大面积皮肤缺损应根据拇指缺损及大鱼际肌缺损情况采用不同的重建修复方式,方可取得较好的临床效果.Objective To describe the method and review the complex thumb defect repaired by combine tissue flap transplantation with the hallux nail flap, the intrinsic muscle of foot and free the second toe. Methods From August 2010 to October 2014, 17 cases with radial side large skin defett combined the thumb Ⅳ degree、Ⅴ degree defect （the big thenar muscle was complete）, were reconstructed by the second digit combination femoral anterolateral flap graft. Radial side large skin defect and big thenar muscle defect with thumb Ⅴ degree、 Ⅵ degree defect in 4 cases were used flap combined with thumb, toe short extensor second digit transplantation to repair and reconstruction. Results Followed-up for 2 years, the reconstruct fingers and transplant flap restored good feeling function, two points discrimination was 3-7 mm. The pinch distanced was reconstructed thumb and fingers less than 1 cm in 7 cases, less than 2 cm in 12 cases, less than 3cm in 2 cases; opposing function of thumb was Ⅲ degree in 16 cases, Ⅱ degree was in 4 cases, Ⅰ degree was in 1 case. Kawabate grading evaluation of hand function was adopted, excellent in 11 cases, good in 9 cases, and poor in 1 case, the good and excellent rate of 95.2%. Reconstructing thumb BMRC sensory function scores, giving a good to excellent rate was 95.2%. Conclusion It＆#39;s an ideal method to repair the complex thumb defect by combine transplantation of theanterolateral thigh flap, the intrinsic muscle of foot and other tissue--transplanting the second toe, hallux nail flap.

关 键 词：手 桡侧毁损伤 组合组织移植 显微外科 

分 类 号：R644[医药卫生—外科学]