急诊拇指再造的适应证分析

Indications for emergency thumb reconstruction with big toe skin-nail flap

目的探讨急诊不同类型拇指缺损再造的最佳适应证。方法对20例拇指脱套伤和6例无再植条件的Ⅱ类拇指离断缺损的创面进行及时、正确的清创与抑菌处理,并采用以足背动脉-跖背动脉(顾玉东Ⅰ、Ⅱ、Ⅲ型者以足背动脉-第一跖背动脉-趾背动脉为动脉蒂,顾玉东Ⅳ型者以足背动脉-第一跖底动脉-趾背动脉为动脉蒂)-趾背动脉为动脉蒂,大隐静脉-足背静脉弓、趾背静脉为静脉蒂,游离趾皮甲瓣的方法行拇再造。结果26例患者的拇指均成活(1例末节皮缘局部坏死,经换药后完全成活),创面一期愈合,平均随访6.5年,再造拇指功能优11例,良13例,可2例。结论急诊拇指缺失,尤其是拇指脱套伤与不能再植的Ⅱ类拇指离断伤,采用游离趾皮甲瓣移植修复的方法是最佳选择。

Objective To analyze the indications for emerg ency thumb reconstruction with big t oe skin-nail flap.Methods 20degloved thumbs and 6severed ones(type II defects)unfavorable for replantation underwent emergency reconstruction with big t oe skin-nail flap after timely and correct debridement and anti-bacteria measures.The dorsal pedal arteries,dorsal me tatarsal arteries(plantar arteries were used in Gu Yu-d ong typeⅣ)and dorsal digital arteries were anastomosed t o the radial arteries.The great saphenous veins,dorsal pedal veins arch,dorsal digital veins were anastomosed to th e cephalic veins.Results All the reconstructed thumbs surviv ed with primary healing of the wound.In 1case,there was slight skin necrosis of the dista l part and the wound healed after chan ge of dressing.The functions of the recon structed thumb were found excellent in 11,good in 13,and fair in 2after an average follow-up of 6.5years.Conclusion Either degloved thumbs or severed on es unfavorable for replantation are the indication for emergency thumb reconstruction with big toe skin-nail flap.[