改良第2足趾再造手拇指术后功能状况及外观形态学特征

Functional status and morphological characteristics of thumb after improved second toe transfer for thumb reconstruction

目的探讨用足拇趾腓侧瓣镶嵌的改良第2足趾再造手拇指的术后功能及外观形态。方法利用趾蹼处的血管吻合形成的交通支,分清趾蹼处血管吻合,切取以趾底动脉为蒂的足拇趾腓侧皮瓣,将其嵌入第2足趾的中节与近节的跖侧狭细处,消除其狭细的外观。结果13例14指全部成功,镶嵌的皮瓣全部成活,再造指的外形逼真。其关节屈曲60°～80°,对掌功能基本恢复。术后1～3个月恢复了痛温触觉及2点分辨觉。术后6个月测量再造拇指与正常拇指的中间周径差异为0.3cm,差异无显著性意义(t=0.02,P>0.05,α=0.05)。结论切取拇趾腓侧瓣镶嵌的改良第2足趾再造拇(手)指的手术方法较传统第2足趾再造拇(手)指的手术方法难度增加不大,再造指功能恢复良好。

AIM:To explore the function and the appearance after operation of an improved method of the second toe transfer for thumb reconstruction modified by the great toe fibular skin flap. METHODS:The communicating branch formed by wascular anastomosis of toe web was used. After distinguishing the vascular anastomosis of the toe web, the fibular shin flap of great toe was mobilized and transected and wedged into metatarsal side of the second toe. To reduce the narrow appearance of the second toe at the middle part, there were few differences between the toe and thumb in the form.RESULTS:All 14 thumbs of 13 cases were reconstitute successfully, and associated flap survived with satisfactory appearance and function. The flexion range of joint was 60°-80°, and the function of opposition was recovered. The thermo taction, algesi taction and 2 point differential range were recovered 1-3 months after operation. The difference in circumference between the reconstructed thumb and the normal thumb was 0.3 cm 6 months after operation without obvious significance(t=0.02 < 0.05, a=0.05). CONCLUSION:It is not difficult to complete the reconstruction by the improved second toe transfer for thumb reconstruction, which is good for the recovery of finger function, as compared to the traditional operation of the second toe transfer for thumb reconstruction.