带足背趾蹼皮瓣的双足三趾移植修复手毁损伤

BILATERAL THREE-TOE TRANSPLANTATION WITH DORSALIS PEDIS FLAP AND FIRST WEB SPACE FLAP FOR DAMAGE INJURY IN THE HANDS

目的探讨修复全手毁损伤的术式及效果。方法本组29例,男22例,女7例。年龄15～31岁。所有患者均从腕部以远皮肤缺损,皮肤挫伤严重,伴有不同程度的掌指骨骨折,皮肤缺损18cm×8cm～22cm×10cm。切取双侧足背、口止母趾近节腓侧、趾蹼皮瓣的双足3趾游离移植修复手毁损伤,其中双侧足背皮瓣修复手掌和手背创面,双侧口止母趾近节腓侧和趾蹼皮瓣重建虎口,双足3趾再造拇指和2个手指。共切取右足23个皮瓣46个足趾,左足6个皮瓣,修复23只右手和6只左手。结果本组58个复合皮瓣,再造拇指29个,手指58个。经1～8年随访,再造手29例87个拇手指全部成活,手外形及功能恢复良好。结论术式最大限度地保留了伤手的残留功能,再造手对指稳定性好,能满足手部活动需要,值得推广应用。

Objective To discuss the surgical method and effect of repair of damage injury in the hands. Methods Of the 29 cases, 22 were males, 7 were females. Their ages ranged from 15 to 31.The size of defect areas ranged from (18 cm×)(8 cm) to (22 cm×)(10 cm).Along with dorsalis pedis flap, lateral hemi-pulp flap was taken from great toe and first web space flap. The second toe was taken from one foot to reconstruct the thumb, second and third toe from another foot was used to reconstruct two fingers. The dorsalis pedis flaps were used to cover palm and dorsum of hand. The lateral hemi-pulp flaps from great toe and first web space flaps were used to reconstruct first web space of hand. Results With the 58 combined flaps, 29 thumbs and 58 fingers were reconstructed. Follow-ups was done for 1 to 8 years.All the thumbs and fingers of 29 hands were reconstructed. Their shape and function were well recovered. Conclusion This new surgical method is effective in preserving the function of injured hand. The function of the injured hands can be preserved by this surgical method, therefore this method is optimal.