髂骨联合同蒂[足母]趾甲皮瓣和足背皮瓣分区再造拇指近节平面缺损  

Reconstruction of proximal thumb plane defect with iliac bone combined with the same pedicled toenail and dorsum pedis flaps

作　　者：王凯[1] 巨积辉[1] 金光哲[1] 郭礼平[1] 郭全伟[1] Wang Kai;Ju Jihui;Jin Guangzhe;Guo Liping;Guo Quanwei(Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou 215104, China)

机构地区：[1]苏州大学附属瑞华医院手外科,215104

出　　处：《中华整形外科杂志》2019年第2期162-165,共4页Chinese Journal of Plastic Surgery

基　　金：江苏省青年医学人才项目(QNRC2016221).

摘　　要：目的探讨髂骨联合同蒂[足母]趾甲皮瓣和足背皮瓣分区瓦合再造拇指近节平面缺损的方法和临床效果。方法2010年6月至2017年5月苏州大学附属瑞华医院手外科收治7例拇指近节不同程度缺损的患者,共7指,男3例3指,女4例4指,年龄18~50岁,平均29岁,5例为拇指近节近端以远缺损,2例为拇指近节远端以远缺损。将需要再造的拇指分为3部分进行修复,即采用髂骨条移植修复骨支架,[足母]趾甲皮瓣修复拇指背侧创面,同蒂足背皮瓣覆盖掌侧创面。皮瓣供区均采用全厚皮片移植修复。结果本组7例手术过程顺利,[足母]趾甲皮瓣切取面积为3.0cm×2.5cm^5.0cm×3.0cm,足背皮瓣面积3.0cm×3.0cm^6.0cm×3.5cm,髂骨移植长度为2.5~5.0cm,再造指体全部成活。随访5~28个月,平均10个月,再造指指腹饱满,指甲生长良好,指体外形良好,指腹皮肤感觉恢复至S2~S3+,全部病例指背均恢复保护性感觉,手指关节功能接近正常;足部供区愈合好,瘢痕不明显,行走完全正常。结论髂骨联合同蒂FDA2趾甲皮瓣和足背皮瓣分区再造术,是一种不牺牲足趾的拇指近节再造的较好方法。Objective To report the method and clinical effect of reconstruction of proximal thumb plane with iliac bone, combined with the same pedicled toenail and dorsum pedis flaps. Methods From June 2010 to May 2017, 7 patients with various degrees of proximal thumb defect were treated in the Hand Surgery Department of Ruihua Affiliated Hospital of Soochow University. Among them, there were 3 males and 4 females, aged from 18 to 50 years, with an average age of 29 years. There were 5 cases of proximal thumb defect and 2 cases of distal thumb defect. The thumb reconstruction contained 3 steps: iliac bone graft was used to repair bone defect, toenail skin flap to repair dorsal thumb wound, and dorsum pedis flap to cover volar wound. Full thickness skin graft was used to repair donor site. Results All the reconstructed fingers survived. The area of toenail skin flap was 3.0 cm×2.5 cm to 5.0 cm×3.0 cm in size. The area of dorsum pedis skin flap was 3.0 cm×3.0 cm to 6.0 cm×3.5 cm in size. The length of iliac bone graft was 2.5-5.0 cm. The follow-up time was 5-28 months, with an average of 10 months. All reconstructed finger pulp was full. The nails grew well. The appearance of fingers was satisfied, and the skin sensation of finger belly was restored to S2 to S3+. Dorsum finger′s protective sensation of all cases were recovered, and the functions of finger joint were close to normal. The donor area on foot healed well. The scar was not obvious. The walking function was completely normal. Conclusions It is a good method to reconstruct proximal thumb with iliac bone combined with the same pedicled toenail and dorsum pedis flaps without sacrificing toes.

关 键 词：外科皮瓣 游离皮瓣 [足母]趾甲皮瓣移植术 拇指再造术 

分 类 号：R658.2[医药卫生—外科学]