不同形式的第二趾甲皮瓣移植修复不同程度的手指皮肤脱套伤

Transfer of several types of wrap-around flap from the second toe to repair various degrees of degloving injury of the fingers

目的总结第二趾甲皮瓣的临床应用效果并探索手指皮肤脱套伤最合理的治疗方案。方法根据手指皮肤脱套伤的特点,将83例95指手指皮肤脱套伤分为二度。Ⅰ度脱套伤:2～5指皮肤脱套范围自指中节中段至指尖,采用单纯第二趾甲皮瓣修复,共59指。Ⅱ度脱套伤:2～5指皮肤脱套范围自指根部至指尖,采用带足背皮瓣的第二趾甲皮瓣修复,共36指。结果95块甲皮瓣全部存活。术后65指随访8个月～5年10个月,失访30指。按中华医学会手外科学会拇、手指再造功能评定试用标准评定,优62指、良3指。结论第二趾甲皮瓣是治疗手指皮肤脱套伤最合理的方法之一。对手指皮肤脱套伤的伤情进行分度,有利于治疗方案的选择。

Objective To summarize the treatment outcome of using wrap-around flap from the second toe to repair degloving injuries of the fingers. Methods 95 degloved fingers of 83 patients were treated. The degloving injuries were classified as Class I in 59 fingers where degloving was extended from fingertip to middle phalangeal level. 36 degloving injuries were classified as Class II since degloving was extended to the entire finger. Fingers of Class I degloving were repaired with single wrap-around flap from the second toe. Fingers of Class II degloving were repaired with wrap-around flap from the second toe and dorsalis pedis flap. Results 65 fingers were followed from 8 months to 5 years and 10 months. 30 fingers were lost to follow up. All the flaps survived. According to the criteria issued by the Hand Surgery Society of Chinese Medical Association for functional assessment of reconstructed thumb and fingers, 62 were graded excellent and 3 good. Conclusion Wrap-around flap from the second toe was one of the best options to repair degloving injury of the fingers. Classification of the injury according to the degree of degloving is helpful in decision making.