第2足趾组织瓣联合趾腓侧皮瓣的临床应用

Clinical application of vascularized tissue flap of second toe combined with fibular pulp flap of big toe

目的探讨第2足趾组织瓣联合趾腓侧皮瓣的临床应用。方法2000年始,临床应用21例,其中趾腓侧皮瓣镶嵌于第2足趾跖侧2例、修复3度以上拇指缺损7例、第2趾末节带中、近节皮瓣联合趾腓侧皮瓣修复食指皮肤脱套伤2例、第2足趾再造手指联合距母趾腓侧皮瓣修复虎口、邻指或附近皮肤缺损10例。结果20例再造指和皮瓣均成活,1例为小儿拇指再造,其足趾成活良好而距母趾腓侧皮瓣坏死,经二期植皮后治愈。经6～14个月随访,再造指、皮瓣外观良好,17例再造指伸、屈、抓、捏功能满意,4例轻度活动受限;距母趾腓侧皮瓣耐磨无臃肿。移植组织两点辨别觉8～12mm。结论第2足趾联合距母趾腓侧皮瓣移植修复复合性手创伤,只吻合一套血管系统,手术简便、实用,为再造手指并同时修复局部皮肤缺损提供了较好的术式。

[Objective] To explore the clinical application of vascularized the tissue flap of the second toe combined with fibular pulp flap of the big toe. [Methods] Since 2000, 21 cases have been applicated, in which, reconstruction of the thumb with the second toe wedged by the great toe fibular flap in 2 cases. Reconstruction of the thumb defect over Ⅲ degree in 7 cases. Repair of the index finger avulsion with the second toe flap with middle and dorsal phalange combined with fibular pulp flap of the big toe. Reconstruction of the thumb and the fingers by the second toe and repair the skin defect of the first web and nearby the injury finger in 10 cases. [Results] The reconstruction fingers and flaps in 20 cases were all survived, one case of a child whose transfer toe was survived but whose fibular pulp flap of the big toe was necrosis, at last healed by skin grafted in Ⅱstage. Followed up 6～14 months, reconstructed fingers and flaps have good appearance, 17 cases gained the function of extend, flex, grasp and pinch, 4 cases whose function were mild limited, the fibular pulp flap of the big toe was not swelling. 2-PD of the transfer tissues were 8～12 mm. [Conclusions] Repair of complex hand injury with the second toe and fibular pulp flap of the big toe, witch is simple, practicality and only anastomose one suit of blood vessel, it is a good approach for reconstruction finger and repair skin defect in one precedure.