游离踇甲皮瓣移植在重建甲床及指尖缺损中的应用  

Reconstruction of nail bed and fingertip defects with free nail flap

作　　者：沈永辉[1] 万绍乐 蔡森 Shen Yonghui;Wan Shaole;Cai Sen(Department of Orthopedics,Lishui People′s Hospital,Lishui 323000,China)

机构地区：[1]丽水市人民医院骨科,丽水323000

出　　处：《中国医师杂志》2023年第3期402-405,410,共5页Journal of Chinese Physician

基　　金：浙江省医药卫生科技计划项目(2021ZH012)。

摘　　要：目的探讨游离踇甲皮瓣在重建甲床及指尖缺损中的应用价值。方法回顾性分析2018年1月至2020年6月丽水市人民医院骨科需进行游离踇甲皮瓣移植治疗的9例指尖缺损患者病历资料。根据Allen分类方法,6例患者为Ⅱ型,3例为Ⅲ型,根据患者的医疗记录和随访情况进行评价,包括受区和供区术后愈合情况、两点辨别情况、中华医学会手外科学会断指再植功能评定试用标准、密歇根大学手概况问卷调查表(MHQ)及足部功能评价表(FFI)。结果所有患者均顺利完成手术,手术时间3.0~5.0 h,平均4.1 h,术中失血量100~250 ml,平均178 ml,术后随访时间12~40个月,平均25个月。所有患者的指甲和皮瓣均存活,伤口均一期愈合,术后未观察到并发症。9例患者重建手指外观与健侧相近,皮瓣两点辨别能力为5.0~7.5 mm,再植评分和MHQ问卷结果满意;供趾良好,行走时无畸形或疼痛。结论采用游离踇甲皮瓣治疗指尖缺损,具有修复组织缺损,重建甲床,保持手指长度获得满意的临床效果。Objective To explore the application value of free nail flaps in reconstruction of nail bed and fingertip defect.Methods From January 2018 to June 2020,nine patients with free nail flap transplantation to treat fingertip injuries in Lishui People′s Hospital were included in this study.According to the Allen classification,6 patients were characterized as typeⅡand 3 were characterized as typeⅢ.Evaluation was based on the patients′medical records and follow-up,including postoperative healing of recipient and donor sites,two-point discrimination,the Chinese Medical Association Hand Surgery Society′s evaluation of the function of severed finger replantation,and Michigan Hand Outcomes Questionnaire(MHQ)and Foot Function Index(FFI).Results All patients successfully completed the operation,the operation time was 3.0-5.0 h(average 4.1 h),the intraoperative blood loss was 100-250 ml(average 178 ml),and the follow-up time was 12-40 months(average 25 months).The nails and flaps of all patients survived with primary healing.No complications were observed after surgery.The appearance of the reconstructed finger of 9 patients was similar to that of the uninfected side;the flap two-point discrimination was 5.0-7.5 mm;the replantation score and MHQ results were satisfactory.The toenail of the donor site grew well,and no deformity or pain with walking was noted.Conclusions The free toenail flap was used to treat fingertip defects,with satisfactory clinical results in repairing tissue defects,reconstructing nail bed and maintaining finger length.

关 键 词：指损伤 皮肤移植 游离组织瓣 指(趾)甲 拇趾 

分 类 号：R622[医药卫生—整形外科]