前臂内侧皮神经营养血管蒂皮瓣在修复拇指缺损中的应用

Application of forearm neurocutaneous pedicled flap in the reconstruction of thumb defect

目的:探讨趾移植再造拇指ⅢB缺损时鱼际及虎口处皮肤缺损的修复方法。方法:在解剖学研究的基础上,对资料完整的7例拇指ⅢB缺损再造术进行回顾:所有病例均为陈旧性损伤,行游离第二足趾移植后单纯鱼际处缺损2例,鱼际处及虎口皮肤同时缺损5例。采用前臂内侧皮神经营养血管蒂皮瓣修复鱼际处及虎口处的皮肤缺损,皮瓣切取面积为4cm×8cm～6cm×14cm。结果:所有皮瓣均成活,2例因旋转点蒂部缝合过紧造成皮瓣远端1/5部分皮肤坏死,经植皮后愈合。所有病例经3个月～2年的随访,再造拇指成活,鱼际处饱满,无跖骨及屈肌腱外露,虎口无明显挛缩。第1跖骨与第2掌骨夹角大于30°。外形满意,功能好。结论:前臂内侧皮神经营养血管蒂皮瓣是修复拇指ⅢB缺损行游离第二足趾移植时形成的鱼际及虎口处皮肤缺损的良好方法,具有血运可靠,易操作,风险小等优点。

Objective： To investigate the repairing methods of skin defects of thenar eminence and the first dorsal intermetacarpal part during the reconstruction of thumb IIIB defect by toe transplantation. Methods： On the basis of anatomic researches, 7 cases of thumb reconstruction with intact case recordings were analyzed retrospectively. All cases were old injuries, which included： simple thenar skin defect 2 cases after flee transplantation of second toe; combined skin defect of thenar and the first dorsal intermetacarpal part 5 cases. To repair skin defect, forearm neurocutaneous pedicled flaps were adopted with harvesting areas of about 4cm ×8cm- 6cm×14cm. Results： All flaps survived, with 1/5 part of skin necrosis occurred in 2 cases due to over-tightened suture on rotation point but healed after skin grafting. After 3 months-2 years follow-up, all reconstructed thumb survived, with satiety of the ball of thumb, without exposure of bone and flexor tendon and contracture of the first dorsal intermetacarpal part. Angles between the first and the second metacarpal were more than 30°, with satisfied appearance and function. Conclusions： Forearm neurocutaneous pedicled flap is a good method for repairing of thenar skin defect during reconctruction thumb IIIB defect with the second toe transplantation. It is reliable for blood supply and easy to perform.