游离 甲瓣修饰性再造拇指脱套伤  

Aesthetic reconstruction of thumb dislodgement injury by free wrap-around flap

作　　者：王先威 田永宾 马春英 倪建峰 WANG Xianwei;TIAN Yongbin;MA Chunying(Department of Orthopedics,No.272 Hospital,Tianjin,300021,China)

机构地区：[1]天津二七二医院骨科,天津300021 [2]天津市急救中心,天津300000

出　　处：《实用手外科杂志》2025年第1期41-43,47,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨应用游离 甲瓣修饰性再造拇指脱套伤的方法和临床疗效。方法2018年3月-2023年3月,对11例拇指脱套伤患者采用游离同侧 甲瓣修饰性再造拇指的方法给予治疗。其中,根据拇指皮肤脱套情况,携带足背皮瓣6例,单纯切取 甲瓣5例;急诊手术7例,择期手术4例。所有病例术后均获得规律随访。结果术后11例再造拇指均全部成活,其中1例术后第3天出现静脉危象,经过急诊手术探查、重新吻合血管后危象解除,再造指体成活。术后随诊6~24个月,平均11.8个月,再造拇指同健侧拇指相比,外形极为逼真,手指功能优良,再造手指指尖恢复保护性感觉。 甲瓣足部供区外形满意,足趾行走功能正常。结论应用游离 甲瓣修饰性再造拇指脱套伤,再造指体外形美观,功能良好,皮肤色泽红润,质地柔软,供区功能无影响,临床疗效显著,值得推广。Objective To explore the method and clinical efficacy of using free wrap-around flap for aesthetic reconstruction of thumb degloving injury.Methods From March 2018 to March 2023,11 patients with thumb degloving injury were treated with aesthetic thumb reconstruction by free ipsilateral wrap-around flap.Among them,based on the situation of thumb skin detachment,6 cases were carried with dorsalis pedis flap,5 cases were simply removed with wrap-around flap,7 cases underwent emergency surgery,and 4 cases underwent elective surgery.All cases received regular follow-up after surgery.Results All 11 reconstructed thumbs survived after surgery,with one patient experiencing venous crisis on the third day after surgery.After emergency surgical exploration and re-anastomosis of blood vessels,the crisis was resolved and the reconstructed finger body survived.Postoperative follow-up was 6 to 24 months,with an average of 11.8 months.Compared with the healthy thumb,the reconstructed thumb had a very realistic appearance and excellent finger function.The reconstructed finger tip restored a protective sensation.The shape of the foot donor area of the wrap-around flap was satisfactory,and the walking function of the toes was normal.Conclusion The application of free wrap-around flap for aesthetic reconstruction of thumb degloving injury has a beautiful appearance,good function,red and smooth skin color,soft texture,and no impact on donor function.The clinical efficacy is significant and worthy of promotion.

关 键 词：游离甲瓣 修饰性再造 拇指脱套伤 

分 类 号：R65[医药卫生—外科学]