游离[足母]甲瓣在拇指末节缺损再造中的临床应用及疗效分析  

Clinical application and therapeutic analysis of free wrap-around flap transfers in the reconstruction of distal thumb defects

作　　者：罗盼 欧昌良 江吉勇 LUO Pan;OU Changliang;JIANG Jiyong(Department of Orthopedics,Guizhou Provincial People's Hospital,Guiyang 550002,Guizhou,China;Department of Orthopedics,the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,Guizhou,China)

机构地区：[1]贵州省人民医院骨科,贵州贵阳550002 [2]贵州中医药大学附属第一医院骨科,贵州贵阳550001

出　　处：《中国现代手术学杂志》2024年第5期347-350,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的 探讨游离[足母]甲瓣在拇指末节缺损中的临床应用,并进行疗效分析。方法 2019年2月至2022年9月,贵州省人民医院骨科手显微组对收治的12例拇指末节缺损患者,采用游离[足母]甲瓣再造修复。其中,游离同侧[足母]甲瓣7例,对侧5例。拇指末节皮肤缺损伴桡侧指骨或指甲缺损8例,尺侧指骨或指甲缺损4例,指骨缺损均未超过指间关节。压砸伤6例,机械伤3例,切割伤3例。手术采用一期清创,二期游离[足母]甲瓣移植修复。缺损面积2.5 cm×1.5 cm~3.5 cm×2.5 cm,皮瓣切取面积3.0 cm×2.0 cm~4.0 cm×3.0 cm,趾骨切取长度0.5~1.8 cm。甲瓣供区直接闭合9例,3例带蒂皮瓣修复。术后门诊或微信定期随访。结果 12例[足母]甲瓣均顺利成活,所有患者均获随访,平均随访时间11(3~14)个月。拇指末节缺损的患者,11例术后拇指功能恢复良好,纹理、质地与健侧手指相近,外形美观;1例并发拇指甲沟炎,经换药后愈合良好。按中华医学会手外科学会上肢部分功能评定试用标准,优9例,良2例,中1例;按照英国医学研究会评定标准,皮瓣感觉均恢复至S3^(+)。所有甲瓣供区除可见线形瘢痕外,无功能影响。结论 游离[足母]甲瓣移植再造修复拇指缺损,可以重建拇指复合组织缺损,不仅能恢复拇指的外观、感觉及功能,而且对供区损伤较小,疗效满意,是一种较为理想的临床应用方法。Objective To explore the clinical application and therapeutic analysis of free wrap-around flap transfers in thumb distal segment defects.Methods From February 2019 to September 2022,the Hand Microscopy Group of the Orthopedics Department of Guizhou Provincial People's Hospital used free wrap-around flap transfers to repair 12 cases of distal thumb defects.Among them,there were 7 cases of free ipsilateral toenail flaps and 5 cases of contralateral toenail flaps.There were 8 cases of skin defects at the distal end of the thumb accompanied by radial phalangeal or nail defects,and 4 cases of ulnar phalangeal or nail defects.The phalangeal defects did not exceed the interphalangeal joint.There were 6 cases of crushing injuries,3 cases of mechanical injuries,and 3 cases of cutting injuries.All surgeries were performed with primary debridement and secondary free toenail flap transplantation for repair.The defect area ranged from 2.5 cm×1.5 cm to 3.5 cm×2.5 cm,and the skin flap had a cutting area of 3.0 cm×2.0 cm to 4.0 cm×3.0 cm,and the toe bone had a cutting length of 0.5 cm to 1.8 cm.9 cases had direct closure of the great toenail flap donor site,and 3 cases had pedicle flap repair.Results All 12 cases of free wrap-around flap transfers survived smoothly,and all these patients were followed up for 3~14 months,with an average of 11 months.Eleven patients with distal thumb defects had good postoperative recovery of the thumb function,with similar texture to the healthy finger and nice appearance.The remaining one had concurrent paronychia of the thumb,which healed well after dressing change.According to the evaluation criteria of the Chinese Society of Hand Surgery for upper limb function,there were 9 cases of excellent,2 cases of good,and 1 case of moderate.According to the evaluation criteria of the British Medical Research Association,the sensation of the skin flaps recovered to S3^(+).All the donor sites healed with a visible linear scar,and had no functional impact.Conclusion Free wrap-around flap transplantat

关 键 词：[足母]甲瓣 拇指缺损 指尖再造 显微外科技术 

分 类 号：R65[医药卫生—外科学]