应用[⻊母]趾腓侧与第二足趾胫侧皮瓣修饰性再造拇手指末节缺损  

Application of modified flap from the fibular side of the great toe and the tibial side of the second toe for reconstruction of thumb and finger distal segment defects

作　　者：董书男 刘承伟 于玉芝 江吉勇 黄东 彭龙 关翰辉 弓贺炜 Dong Shunan;Liu Chengwei;Yu Yuzhi;Jiang Jiyong;Huang Dong;Peng Long;Guan Hanhui;Gong Hewei(Department of Upper Limb Repair and Reconstruction,Guizhou Hospital,Beijing Jishuitan Hospital,Guiyang 550014,China;Department of Hand Surgery,Guangzhou Heping Orthopedic Hospital,Guangzhou 510220,China)

机构地区：[1]北京积水潭医院贵州医院上肢修复重建外科,贵阳550014 [2]广州和平骨科医院手外科,广州510220

出　　处：《中华手外科杂志》2024年第4期360-364,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨应用[⻊母]趾腓侧与第二足趾胫侧皮瓣修饰性再造拇、手指末节缺损的临床疗效.方法自2018年1月至2021年12月我们共收治拇手指末节组织缺损患者30例,12例拇指、2例示指、2例中指末节缺损病例采用[⻊母]趾腓侧皮瓣修复,6例示指、3例中指末节缺损采用第二趾胫侧皮瓣修复,5例2个及以上手指指端缺损采用[⻊母]趾腓侧与第二足趾胫侧皮瓣联合应用修复.术后予显微外科常规护理,记录皮瓣存活情况.出院后定期随访皮瓣外观、皮瓣两点分辨觉、手指甲板外观、指关节屈伸活动功能、手功能评分、足部供区恢复情况.结果本组30例皮瓣全部存活.末次随访时再造拇手指外观与对侧拇手指相似,皮瓣质地良好,指腹两点分辨觉为3~10 mm.手功能按中华医学会手外科学会评分:优26例,良4例.30例病例再造指指间关节屈伸活动良好.所有病例足部供区切口愈合良好,足部行走、跑跳无影响.本组所有患者对手术效果均满意.结论应用[⻊母]趾腓侧与第二足趾胫侧皮瓣修饰性再造拇手指末节各类组织缺损,再造拇、手指外形美观,感觉功能良好,足部供区损伤小,且两种皮瓣优势互补,血供同源,切取方法类似,是各类拇、手指末节缺损的理想修复方式.Objective To evaluate the clinical efficacy of modified flap from the fibular side of the great toe and the tibial side of the second toe for reconstruction of thumb and finger distal segment defects.Methods From January 2018 to December 2021,a total of 30 patients with thumb and finger distal segment defects were treated in our department.12 cases of thumb,2 cases of index finger,and 2 cases of middle finger distal segment defects were repaired using the fibular flap of the toe.6 cases of index finger and 3 cases of middle finger distal segment defects were repaired using the tibial flap of the second toe.5 cases of 2 or more fingers distal segment defects were repaired using a combination of the fibular flap of the toe and the tibial flap of the second toe.The routine microsurgical care after surgery was performed and the survival of the skin flap was recorded.After discharge,regular follow-up was conducted on the appearance of the skin flap,two-point discrimination of the skin flap,appearance of the nail,flexion and extension function of the finger joint,hand function score,and recovery of the foot donor area.Results All 30 skin flaps survived.At the last follow-up,the appearance of the reconstructed thumb finger was similar to that of the contralateral thumb finger,with good skin flap texture and a two-point discrimination of 3 to 10 mm on the fingertip.According to the rating of the Hand Surgery Society of the Chinese Medical Association,there were 26 cases with excellent hand function and 4 cases with good hand function.30 cases showed good flexion and extension activity of the reconstructed fingers.All cases had good healing of incisions in the foot donor area,and there was no impact on foot walking and running.All patients were satisfied with the surgical results.Conclusion The application of modified flap from the fibular side of the great toe and the tibial side of the second toe for reconstruction of thumb and finger distal segment defects can achieve a beautiful appearance of reconstructed thumb and f

关 键 词：外科皮瓣 治疗结果 修饰性再造 指末节缺损 

分 类 号：R658[医药卫生—外科学]