吻合第一足趾甲床神经分支甲皮瓣再造手指的疗效研究  

Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed

作　　者：李学川[1] 张玲玲 孙长胜 张辉 李文君 LI Xuechuan;ZHANG Lingling;SUN Changsheng;ZHANG Hui;LI Wenjun(Department of Burn,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200025,P.R.China;Department of Hand and Foot Microsurgery,Shanghai Zhongye Hospital,Shanghai,201941,P.R.China)

机构地区：[1]上海交通大学医学院附属瑞金医院烧伤科,上海200025 [2]上海中冶医院手足显微外科,上海201941

出　　处：《中国修复重建外科杂志》2023年第12期1496-1500,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：上海市宝山区医学重点学(专)科及特色品牌建设项目(BSZK-2023-BZ11)。

摘　　要：目的探讨利用吻合第1足趾甲床神经分支的甲皮瓣再造手指疗效。方法2016年1月—2022年12月,收治18例(18指)拇、手指甲床缺损患者。男12例,女6例;年龄19~42岁,平均32岁。致伤原因:机器挤压导致指尖组织毁损14例,手指再植术后远端组织坏死4例。损伤指别:拇指9例,示指3例,中指5例,环指1例。损伤部位:指甲中部以远11例,甲根(含甲根)以远7例。患者受伤至入院时间1~5 h,平均2 h。清创后创面范围为1 cm×1 cm~4 cm×3 cm。抗感染治疗5~7 d后行吻合第1足趾甲床神经分支的甲皮瓣再造指尖,甲皮瓣切取范围1.5 cm×1.5 cm~4.5 cm×3.5 cm。供区创面以皮瓣修复16例,游离植皮修复2例。结果术后供受区甲皮瓣、皮瓣及植皮均顺利成活,创面Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均10个月。18例指甲全部生长,其中16例指甲平整、外形满意,1例指甲不平整,1例缝合口周围瘢痕增生明显。术后6个月皮瓣两点辨别觉为4~8 mm,平均6 mm。供区植皮及皮瓣均恢复保护性感觉,耐磨性良好,未诉对行走、穿鞋造成不良影响。结论利用吻合第1足趾甲床神经分支的甲皮瓣再造手指损伤较小,可获得良好甲床修复效果。Objective To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed.Methods Between January 2016 and December 2022,18 patients(18 fingers)with thumb or finger nail bed defects were admitted.There were 12 males and 6 females,with an average age of 32 years(range,19-42 years).Four cases were finger tip tissue damage caused by machine compression,and 4 cases were distal tissue necrosis after finger replantation.There were 9 cases of thumb injury,3 cases of index finger injury,5 cases of middle finger injury,and 1 case of ring finger injury.There were 11 cases of distal nail damage and 7 cases of distal nail root(including nail root)damage.The time from injury to admission was 1-5 hours,with an average of 2 hours.After debridement and anti-infection treatment for 5-7 days,the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed.The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm.The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases.Results All nail flaps,flaps,and skin grafts survived after operation and the wounds healed by first intention.All patients were followed up 6-12 months(mean,10 months).The nails of 18 cases were all grown,in which 16 cases had smooth nails with satisfactory appearances,1 case had uneven nails,and 1 case had obvious scar hyperplasia around the suture opening.At 6 months after operation,the two-point discrimination of the skin flap was 4-8 mm(mean,6 mm).Meanwhile,the skin grafts and flaps at the donor sites regained protective sensation,good abrasion resistance,and had no negative effect upon walking and wearing shoes.Conclusion The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.

关 键 词：手指再造 甲床再造 指尖缺损 第1足趾甲床神经分支 

分 类 号：R658.2[医药卫生—外科学]