不牺牲足趾的修饰性第2足趾趾甲瓣再造手指末节  

Aesthetic reconstruction of distal segment of finger with modified second toe nail flap without sacrifice a toe

作　　者：宿晓雷[1] 余航[1] 高艳红[1] 李统[1] 张宁[1] 陈广先[1] 李闯 常文利 王鸿飞[1] 赵建勇[1] XIU Xiaolei;YU Hang;GAO Yanhong;LI Tong;ZHANG Ning;CHEN Guangxian;LI Chuang;CHANG Wenli;WANG Hongfei;ZHAO Jianyong(Department of Hand Microscopic Surgery,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou,Hebei Province 061001,China)

机构地区：[1]河北省沧州中西医结合医院手显微外一科,河北沧州061001

出　　处：《中华显微外科杂志》2022年第2期148-151,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨应用第2足趾趾甲瓣修复手指末节脱套伤同时保留第2足趾全长的手术方法和效果。方法2018年4月-2020年6月,共收治手指末节脱套伤16例,其中男11例,女5例;年龄18~45岁,平均29岁;均为手指末节脱套伤,其中示指5例,中指7例,环指3例,小指1例;受伤至手术时间0.5~3.0 h,平均1.5 h。应用第2足趾趾甲瓣修复,将第2足趾腓侧皮瓣旋转至足底跖侧后,其余创面取断层皮片游离移植固定。术后定期随访。结果16例手指皮瓣全部成活;其中1例足趾皮瓣坏死,行第2足趾趾端残端缝合术。全部患者均获随访,随访时间4~12个月,平均5.7个月。全部皮瓣血运良好,皮瓣萎缩后与正常指体直径相当,TPD达6.5(4~10)mm;全部患者均恢复工作。根据中华医学会手外科学会上肢部分功能评定试用标准进行评价:优13例,良2例,可1例。结论应用第2足趾趾甲瓣修复手指末节脱套伤,可以有效地恢复患指的长度及美观,并且可以保留足趾的长度,适宜临床推广。Objective To explore the method and effect of aesthetic reconstruction of distal segment of finger with modified second toe nail flap while retains the full length of the second toe.Methods From April 2018 to June 2020,16 patients with degloving injury of distal segment of fingers were treated.The patients were 11 males and 5 females aged 18 to 45 years in an average of 29 years.All injuries were degloving injury of the distal segment of finger,including 5 index fingers,7 middle fingers,3 ring fingers and 1 little finger.The time from injury to operation was 0.5-3.0 hours,with an average of 1.5 hours.The second toe nail flap was used for the reconstruction.After the dorsal flap of the second toe was rotated to the plantar side of the foot,the donor site defect was repaired by a skin graft.The regular follow up reviews were carried out.Results All 16 flaps survived except 1 flap had necrosis and underwent toe amputation of the distal segment of the second toe.All patients entered follow-up for 4-12 months,with an average of 5.7 months.The blood supply of all flaps was good.After the flaps having atrophied,they were equivalent to the diameter of the body of normal fingers with the TPD at 6.5(4-10)mm;All patients returned to work.According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society,13 cases were graded as excellent,2 were good and 1 was fair.Conclusion The techniques of modified second toe toenail flap in aesthetic reconstruction of the distal segment of a finger can effectively restore the length and aesthetic appearance of the affected finger,without sacrificing the donor toe.Clinical application of it should be promoted.

关 键 词：趾甲瓣 第2足趾 手指末节脱套伤 皮肤移植 修饰性再造 

分 类 号：R658.3[医药卫生—外科学]