基于超级显微外科技术的[足母]趾断层甲床皮瓣修复小儿甲床Ⅲ型缺损  

Transplantation of slice nail bed flap of great toe based on super microsurgery technology for repair of typeⅢnail bed defects in children

作　　者：印飞 王军 薛明宇 顾珺 林伟枫 李甲 Yin Fei;Wang Jun;Xue Mingyu;Gu Jun;Lin Weifeng;Li Jia(Department of Pediatric Orthopedics,Wuxi No.9 People's Hospital Affliated to Soochow University,Wuxi 214000,China;Department of Pediatric Orthopedics,Xuzhou Renci Hospital,Xuzhou 221001,China)

机构地区：[1]无锡市第九人民医院小儿骨科,无锡214000 [2]徐州仁慈医院小儿骨科,徐州221001

出　　处：《中华手外科杂志》2025年第1期24-27,共4页Chinese Journal of Hand Surgery

基　　金：无锡市卫健委适宜技术推广项目(T202228)。

摘　　要：目的:探讨基于超级显微外科技术的游离[足母]趾断层甲床复合组织瓣修复小儿甲床Ⅲ型缺损的临床疗效。方法:自2019年1月至2022年12月,我们应用游离[足母]趾断层甲床复合组织瓣修复小儿指端甲床Ⅲ型缺损创面6例。骨缺损行髂骨植骨,受区血管吻合基于超级显微外科技术,吻合指动脉口径0.6~0.8 mm。[足母]趾供区设计趾腹V-Y皮瓣推进修复,断层甲床供区行人工真皮修复材料覆盖。所有患者术后定期随访手、足甲床外观及手指功能情况。结果:术后所有患者断层甲床复合组织皮瓣均顺利存活。患者均获得随访,时间为12~18个月,平均14.9个月。其中2例甲板出现萎缩,未出现钩甲、疼痛、感觉过敏,甲床恢复情况根据吕桂欣等的指甲损伤修复后疗效评定标准评定:优2例,良4例。手指功能根据中华医学会手外科学会上肢部分功能评定试用标准评定均为优。末次随访皮瓣两点分辨觉为6~8 mm。供区[足母]趾甲生长良好,无畸形,无行走痛。结论:基于超级显微外科技术的游离[足母]趾断层甲床复合组织瓣修复小儿甲床Ⅲ型缺损创面,能有效恢复手指长度及甲床外观,在降低供区损伤的同时避免二期整形,是治疗小儿甲床Ⅲ型缺损的有效方法之一。Objective:To discuss the clinical efficacy of transplantation of slice nail bed flap of geat toe based on super microsurgery technology for repair of typeⅢnail bed defects in children.Methods:From January 2019 to December 2022,a total of 6 cases of typeⅢnail bed defect wounds in children were repaired by slice nail bed fap of great toe.The bone defects were treated with iliac bone grafting,and vascular anastomosis in the recipient area was performed using ultra microsurgical techniques.The diameter of the anastomosed digital artery was 0.6 to 0.8 mm.The toe donor area was repaired by V-Y advancement flap,and the artificial leather repair material was used to cover the slice nail bed donor area.All patients underwent regular postoperative follow-up on the appearance of their hands and foot nail beds,as well as finger function.Results:All patients survived smoothly with the composite tissue flap of the slice nail bed after surgery.All patients were follow-up for a period of 12 to 18 months,with an average of 14.9 months.Among them,2 cases of nail atrophy were observed,without any nail hooks,pain,or hypersensitivity.The recovery of the nail bed was evaluated according to the efficacy evaluation criteria of Lv Guixin,et al.for nail injury repair.The results were excellent in 2 cases and good in 4 cases.The finger function was evaluated as excellent according to the trial criteria for evaluating upper limb function by the Chinese Society of Hand Surgery.The last follow-up showed a two-point discrimination of 6 to 8 mm for the skin flap.The great toe nails in the donor area had good growth,no deformities,and no walking pain.Conclusion:The slice nail composite tissue bed flap of great toe based on super microsurgical technology can effectively restore finger length and nail bed appearance in the repair of typeⅢnail bed defects in children.It reduces donor site damage while avoiding secondary plastic surgery,and is one of the effective methods for treating typeⅢnail bed defects in children.

关 键 词：外科皮瓣 显微外科手术 甲床缺损 [足母]趾甲床皮瓣 

分 类 号：R726.5[医药卫生—儿科]