以[⻊母]横动脉-跖腹静脉为蒂的微型甲皮瓣修复指腹甲床部分联合缺损  

Clinical analysis of mini toe nail flap pedicled with transverse big toe artery and plantar ventral vein for repair of partial combined defect of finger pulpand nail bed

作　　者：范筱 刘金海 劳克诚[1] Fan Xiao;Liu Jinhai;Lao Kecheng(Department of Bone and Joint Surgery,Qingdao Municipal Hospital,Qingdao 26601l,China;Department of Orthopedics,Qingdao Chengyang Ancient Town Orthopedic Hospital,Qingdao 266107,China)

机构地区：[1]青岛市市立医院骨关节外科,青岛266011 [2]青岛城阳古镇正骨医院骨科,青岛266107

出　　处：《中华手外科杂志》2023年第5期463-466,共4页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金(82205149);中国博士后基金(2022M710472)。

摘　　要：目的按探讨应用以[⻊母]横动脉-跖腹静脉为蒂的微型甲皮瓣游离移植修复指腹甲床部分联合缺损的临床疗效。方法自2018年5月至2020年12月,我们应用以[⻊母]横动脉-跖腹静脉为血管蒂的微型甲皮瓣游离移植修复指腹甲床部分联合缺损患者36例36指。术后定期随访,记录术后并发症、指甲生长时间。末次随访时观察手指外观及质地,按照Zook甲床修复评定标准评价指甲修复情况、记录Semmes-Weinstein触压觉及两点分辨觉。结果术后发生静脉危象2例、动脉危象2例,均经手术处理解除血管危象。36例36指全部存活。术后随访时间为21~28个月,平均(24.82±3.66)个月,指甲生长总时间为(11.56±1.78)个月,末次随访时指尖均恢复良好,Zook甲床修复评定疗效,优良率为100%;Semmes-Weinstein触压觉为(0.34±0.17)g,两点分辨觉为(6.33±0.89)mm;根据中华医学会手外科学会上肢部分功能评定试用标准功能评定优良率为100%。[⻊母]趾供区外形及功能良好。结论以[⻊母]横动脉-跖腹静脉为蒂的微型甲皮瓣游离移植修复指腹甲床部分联合缺损是有效的手术方法。Objective To investigate the clinical efficacy of free transplantation of mini toe nail flap pedicled with transverse big toe artery and plantar ventral vein to repair partial combined defect of finger pulp and nail bed.Methods From May 2018 to December 2020,36 patients(36 fingers in total)with partial combined defect of finger pulp and nail bed were treated by free transplantation of mini toe nail flap pedicled with transverse big toe artery and plantar ventral vein.The postoperative follow-up was conducted.The postoperative complications and nail growth time were recorded.The finger appearance and texture were observed at the last follow-up,and the nail repair status was evaluated according to the Zook nail bed repair evaluation standard.The Semmes-Weinstein tactile pressure sensation and two-point discrimination were recorded.Results After operation,the venous crisis occurred in 2 cases and arterial crisis in 2 cases,all of which were relieved by surgical treatment.All 36 fingers of 36 cases survived.The follow-up time after surgery ranged from 21 to 28 months with an average of(24.82±3.66)months,and the total nail growth time was(11.56±1.78)months.At the last follow-up,the fingertips recovered well.According to the Zook nail bed repair evaluation standard,the nail repair status was evaluated as excellent and good rate.The Semmes-Weinstein tactile pressure perception was(0.34±0.17)g,and two-point discrimination was(6.33±0.89)mm.The excellent and good rate of functional evaluation according to the trial standard for functional evaluation of upper limb issued by the Society of Hand Surgery of the Chinese Medical Association was 100%.The shape and function of the toe donor area are good.Conclusion The free transplantation of mini toe nail flap pedicled with transverse big toe artery and plantar ventral vein is an effective surgical method to repair partial combined defect of finger pulp and nail bed.

关 键 词：外科皮瓣 指损伤 电甲床损伤 汉游离移植 重建 

分 类 号：R687.3[医药卫生—骨科学]