第二趾甲瓣移植修复手指末节部分复合组织缺损  

Second toenail flap transplantation for repairing composite tissue defects in the distal segment of the finger

作　　者：杨福强 韩伟娜 王宇豪 刘宏章 侯书健 孙乐天 Yang Fuqiang;Han Weina;Wang Yuhao;Liu Hongzhang;Hou Shujian;Sun Letian(Department of Hand Surgery,No.971 Hospital of the PLA Navy,Qingdao 266071,China;The Eighth People's Hospital of Qingdao,Qingdao 266100,China;No.92132 Unit of the PLA Navy,Qingdao 266400,China)

机构地区：[1]解放军海军第九七一医院手外科中心,青岛266071 [2]青岛市第八人民医院,青岛266100 [3]解放军海军第92132部队,青岛266400

出　　处：《中华手外科杂志》2024年第3期210-214,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨第二趾甲瓣游离移植修复伴有骨质、甲床和指腹缺损的手指(不包括拇指)末节部分复合组织缺损的临床疗效.方法我科自2019年9月至2022年9月收治同时伴有骨质、甲床和指腹缺损的手指末节缺损患者10例10指,均采用游离第二趾甲瓣修复手指部分复合组织缺损.结果术后10例第二趾甲瓣全部存活,供、受区创面均Ⅰ期愈合,无并发症发生,1例术后皮瓣稍显臃肿,行二次修饰性皮瓣修薄术.随访时间6~24个月,平均13个月.手指外观接近正常,指腹饱满,拥有指纹,质地良好,皮瓣色泽与正常无异,两点分辨觉为4~8mm,平均6.5 mm,指甲平整、外形良好,应用温哥华瘢痕评定量表(VSS)对手指及足部供区瘢痕进行评价,手指瘢痕VSS评分平均为0.5分,供区瘢痕VSS评分平均为1.5分,所有病例手指屈伸活动功能正常,足部供区行走及跑跳功能正常,根据中华医学会手外科学会拇、手指再造功能评定试用标准综合评价:优9例,良1例.结论游离第二趾甲瓣移植修复手指末节部分复合组织缺损取得理想效果,虽然手术风险较高,但成功率和患者受益率是可接受的,在不损伤足第一趾前提下,再造手指指甲与指腹外形相对美观,拥有指纹,感觉良好,且供区创伤较小,不仅重建和恢复了手的功能,更重要是获得较好的整形美学效果,减轻了患者的心理压力,具有重要的临床意义.Objective To investigate the clinical efficacy of free transplantation of the second toenail flap for repairing composite tissue defects in the distal segment of fingers(excluding the thumb)with bone,nail bed,and pulp defects.Methods From September 2019 to September 2022,10 patients(10 fingers)with composite tissue defects in the distal segment of fingers accompanied by bone,nail bed,and pulp defects were treated.Free second toenail flap was used to repair partial composite tissue defects in the fingers.Results All 10 cases of the second toenail flap survived after surgery,and the wounds in the donor and recipient areas achieved primary healing without any complications.One case showed slight swelling of the flap after surgery,and a secondary modified flap thinning surgery was performed.The follow-up time was 6 to 24 months,with an average of 13 months.The appearance of the fingers was close to normal,the fingertips were full with fingerprints,good texture,and the skin flap color was not different from normal.The two-point discrimination was 4 to 8 mm,with an average of 6.5 mm.The nails were flat and had a good appearance.The Vancouver Scar Scale(VSS)was used to evaluate the scars in the finger and foot donor areas.The average VSS score for finger scars was 0.5 points,and the average VSS score for donor area scars was 1.5 points.In all cases,the finger flexion and extension function were normal,and the foot donor area walking,running and jumping functions were normal.According to the comprehensive evaluation criteria of the thumb and finger reconstruction function evaluation of the Chinese Society of Hand Surgery,9 cases were excellent,and 1 case was good.Conclusion Free second toenail flap transplantation has achieved ideal results in repairing composite tissue defects in the distal segment of the finger.Although the surgical risk is high,the success rate and patient benefit rate are acceptable.Without damaging the first toe,the reconstructed fingernail and pulp have a relatively beautiful appearance,fingerprint

关 键 词：显微外科手术 治疗结果 第二趾 趾甲瓣 甲床缺损 

分 类 号：R658.2[医药卫生—外科学]