游离[足母]甲骨瓣组合第二足趾胫侧皮瓣再造拇指缺损  

Application of free big toe nail bone flap combined with second toe tibial flap for reconstruction of thumbdefect

作　　者：谭琪 刘光军 张永强 王谦 杨磊 李振 刘祥霞 Tan Qi;Liu Guangjun;Zhang Tongqiang;Wang Qian;Tang Lei;Li Zhen;Liu Xiangxia(Department of Orthopedics,PLA 89th Army Hospital(PLA 89th Hospital),Weifang 261021,China)

机构地区：[1]解放军陆军第八十集团军医院(原解放军第八九医院)骨科,潍坊261021

出　　处：《中华手外科杂志》2019年第6期429-431,共3页Chinese Journal of Hand Surgery

摘　　要：目的介绍一种游离[足母]甲骨瓣与第二足趾胫侧皮瓣组合移植,改良再造拇指缺损的手术方法。方法根据拇指缺损情况,于同侧足第一、二足趾设计切取共干的[足母]甲骨瓣与第二足趾胫侧皮瓣,以[足母]甲骨瓣为主,将切取的第二足趾胫侧皮瓣横向转移到[足母]甲骨瓣的胫侧,与其瓦合重建[足母]甲骨瓣胫侧趾腹和甲皱襞,改善再造拇指外形,减小供区损伤。结果临床应用7例全部存活,供受区创口一期闭合。随访3?15个月,再造指外形美观,功能正常。按中华医学会手外科学会上肢部分功能评定试用标准评定手功能:优5例,良2例。所有患者生活自理,供区足趾损伤小,外形、功能良好。结论游离[足母]甲骨瓣组合第二足趾胫侧皮瓣再造拇指缺损的手术方式能有效改善再造拇指外观,再造指外形对称、美观,功能良好,同时减小供区足趾的损伤。Objective To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap.Methods According to the condition of thumb defect,free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot.The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds,improve the shape of the reconstructed thumb and reduce the damage of the donor site.Results All the 7 cases survived and the donor and recipient wounds achieved primary healing.The postoperative follow-up period ranged from 3 to 15 months.The reconstructed thumb had good appearance and normal function.According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association,the results were graded as excellent in 5 cases and good in 2 cases.All the patients could manage their activities of daily living independently.The donor site had little injury,good shape and function.Conclusion The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb,make the reconstructed thumb symmetrical,beautiful and functional,and reduce the damage of donor toes.

关 键 词：拇指 外科皮瓣 第二足趾 再造 

分 类 号：R65[医药卫生—外科学]