自体足拇趾甲皮瓣移植修复重建手指指甲的疗效评估  

Reconstruction of damaged fingernail with transplantation of the autologous big toenail flap and its clinical efficacy evaluation

作　　者：武竞衡 童德迪 荣艳波 曹梦琪 边涛 WU Jing-heng;TONG De-di;RONG Yan-Bo;CAO Meng-Qi;BIAN Tao(Department of Hand Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing,100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院手外科,北京100035

出　　处：《中国骨与关节杂志》2024年第6期404-408,共5页Chinese Journal of Bone and Joint

摘　　要：目的基于带血管的自体足拇趾甲皮瓣游离移植方法,探讨手指指甲的临床修复重建效果。方法回顾分析2021年5月至2022年5月我院收治的15例手指指甲及软组织缺损的患者,根据指甲缺损大小及足趾趾甲大小,采用带血管的自体足拇趾甲皮瓣游离移植的方法对指甲缺损进行修复重建,并按照国际手外科联合会及中华医学会手外科学会拇手指再造术后评定标准进行疗效评估。结果15例患者的移植指甲及甲皮瓣全部成活。1例患者于术后24 h呈现动脉危象,经移植血管重新吻合后,移植指甲皮瓣的血运恢复。所有患者手指的远端指间关节基本可正常活动,修复后的指甲生长正常;供区足部可承受负荷行走,步态基本正常,未受显著影响,足底不存在溃疡现象。术后全部患者经3~12个月的随访,综合评分优12例,良3例,参照Zook(1984年)指甲修复的评定标准,优良率为87.5%,患者均满意术后疗效。结论采用自体带血管的足拇趾甲皮瓣可移植修复重建指甲缺损和修复神经,最大限度改善手指的外观和功能。Objective To evaluate the clinical therapeutical efficacy of the reconstruction and reparation of damaged fingernail by transplanting the autologous big toenail flap.Methods A retrospective analysis of the selected 15 patients in our hospital suffered from fingernail and soft tissue defects between May 2021 and May 2022 was performed.The damaged fingernail was repaired and reconstructed via the transplantation of autogenous vascularized big toenail flap based on the size of fingernail defect and big toenail.The clinical efficacy was estimated according to the evaluation standard for thumb and finger reconstruction founded by International Federation of Society for Surgery of the Hand and Society of Hand Surgery of Chinese Medical Association.Results All transplanted fingernails and nailflaps of 15 patients survived.Vascular crisis appeared on one patient at 24 h after surgery;however,the vascular crisis was restored after blood vessel grafts and re-anastomosis.The mobility of the distal interphalangeal joints of all patients almost returned to normal,and the repaired fingernail grew normally.The walking function of the foot in the donor area was not significantly influenced,displaying a normal gait;the patients can walk with a load without the formation of plantar ulcer.After 3-12 months'follow-up,12 cases were comprehensively graded as excellent and 3 cases graded as good.According to the EG ZooK(1984)evaluation standard of nail recovery,the good rate reached as high as 87.5%.All patients were satisfied with the postoperative results.Conclusions Reconstructing damaged fingernails via the transplantation of autologous vascularized toenail flap has been certified to be effective in repairing fingernail defects and damaged nerve,thereby facilitating the recovery of finger appearance and function.

关 键 词：指(趾)甲 创伤和损伤 游离组织瓣 显微外科手术 

分 类 号：R658.1[医药卫生—外科学] R622.9[医药卫生—临床医学]