拇手指部分缺损的修饰性修复与重建

Decorative repair and reconstruction of subtotal defect of thumb and finger with trimmed toe flap transfer

目的评估对拇、手指末节部分缺损,选用相应部分足趾组织移植修饰性修复与重建的临床效果,提出修饰性修复与重建的新理念.方法对77例80指拇、手指末节半侧、背侧、指腹及手指部分复合组织缺损选用足趾末节半侧甲瓣,背侧甲瓣,趾腹皮瓣及足趾相应部分复合组织移植,采用吻合趾-指动静脉重建血液循环,施行修饰性修复与重建.结果成活75例78指,成活率为97.5%,术后经半年～12年随访,保持了手指原来长度与外形,重建了指甲,使指腹饱满,具有罗纹,出汗,两点分瓣觉为4～6 mm,获得较完美的外形与功能.结论对拇、手指末节部分复合组织缺损,选用相应部分足趾半侧甲瓣、背侧甲瓣、趾腹皮瓣及复合组织移植的修饰性修复与重建,可达到精细修复效果和修饰性修复与重建的目的.

Objective To summarize the new procedure for decorative repair and reconstruction of subtotal defect of thumb and finger with trimmed toe flap transfer. Methods Seventy-seven patients with 88 thumb and/or finger subtotal defect in the form of lateral half, dorsal half, pr volar half composite tissue defect were reconstructed with the lateral nail-skin flap, dorsal nail-skin flap, or pulp flap taken from the corresponding parts of toes. Blood circulation was re-established by anatomize the digital arteries of the toes and fingers. Follow-up was conducted for 6 months to 12 years. Result Seventy-eight in 77 cases survived with an overall survival rate of 97. 5%. The surviving fingers all preserved usual length, fine-looking appearance, with nail and full pulp, and normal functions, including sweating function and a two-pointdiscrimination of 4 -6 mm. Conclusion Better than any traditional toe-to-hand transfer, the procedure of repair and reconstruction of subtotal defect of thumb and finger with trimmed toe flap transfer not only restore the function of the wounded thumb and/or finger, but also help the objective of decoration.