带瓶样足背皮瓣的第二趾甲皮瓣修复全手指皮肤套脱伤

Repair of degloving injuries of the fingers with second toe wrap-around flap combined with dorsal flap of the foot

目的探讨修复全手指皮肤套脱伤的新术式。方法选用带瓶样足背皮瓣的第二趾甲皮瓣修复全手指皮肤套脱伤8例10指。切取第二趾甲皮瓣及足背皮瓣(长度9～12cm),足背皮瓣切取面积为3cmx4cm～8cm×9cm。皮瓣血供重建方式为趾一指血管吻合及第一跖背动脉与指总动脉或桡动脉吻合。结果术后皮瓣全部存活。随访6～12个月,手指外形及屈、伸功能满意,皮瓣两点分辨觉为6～9mm。1指远侧指间关节屈曲略受限。1指远侧指间关节僵直,但不影响近侧指间关节功能,手功能评定：优8指,良2指。结论带瓶样足背皮瓣的第二趾甲皮瓣修复全手指皮肤套脱伤,修复后的手指功能外形满意,可最大限度地恢复伤指的外形和功能。

Objective To introduce a new surgical procedure for repair of degloving injuries of the fingers. Methods 10 degioved fingers in 8 cases were repaired by wrap-around flap from the second toe with dorsal flap of the foot, the length of which being from 9.0 cm to 12.0 cm and the size being 3 cm × 4 cm to 8 cm × 9 cm. The blood supply of the flaps was restored by anastomosing the arteries, veins of the flaps with the vessels of fingers, namely plantar digital artery to digital artery and fast dorsal metatarsal artery to common digital artery or the radial artery. Results All flaps survived. Satisfactory appearance and good extension-flexion function was obtained with normal sensation and 2-PD of 6 mm to 9 mm after 6 - 12 months＇ follow-up. Limited distal interphalangeal （DIP） joint flexion was noticed in 1 case and DIP joint stiffness in another case. Conclusion Transfer of wrap-around flap from the second toe with dorsal flap of the foot could primarily repair the degioved fingers. The function and appearance of the reconstructed fingers were satisfactory.