指甲延长术在第二足趾移植再造拇手指中的应用

Application of nail lengthening in free second toe transfer for reconstruction of the thumb/finger

目的总结指甲延长术在第二足趾游离移植再造拇、手指中的临床经验。方法对6例行第二足趾移植再造拇指(5例)、中指(1例)的患者,进行指甲延长术。其中一期手术5例,二期手术1例。在距甲根皮缘约5．0～6．0 mm处,去除一块矩形皮肤,勿损伤皮下血管网。其高度约2．0～3．0 mm,宽度与趾甲相等,将“U”形皮瓣向近端轻柔推剥后缝合。结果术后1例足部供区发生浅表感染,经换药后愈合。6例再造拇、手指及甲部皮瓣全部存活。术后随访7个月～2年,平均13个月。再造拇、手指指甲生长良好,与健侧第二趾相比,指甲增加长度为2．0～3．0 mm,外形较满意。结论对第二足趾游离移植再造拇、手指中应用指甲延长术,可改善再造指指甲的外形,术后指甲生长无畸形,是一种简单有效的手术方法。

Objective To summarize the clinical experience of nail lengthening in free second toe transfer for reconstruction of the thumb/finger. Methods Six cases of thumb/finger defect （5 thumbs and I middle finger） treated with second toe transfer underwent nail lengthening using the following technique. A rectangle skin was resected at a distance of 5.0 to 6.0 mm from the eponychium, with care taken to leave the underlying subcutaneous vascular network intact. It was 2.0 to 3.0 mm high and as wide as the toe nail. The＂U＂ shape gap then was gently slided proximally and its ends sutured. Results One case sustained superficial infection postoperatively at the donor site and the wound healed after daily wound dressing changes. All the reconstructed thumbs/finger survived completely and the postoperative course was uneventful. At 7 to 24 months （average 13 months） follow-up, growth and appearance of the nail was good. There was 2 to 3 mm increase in the length of the nail as compared to that of the normal second toe. Conclusion Nail lengthening in free second toe transfer for reconstruction of the thumb/finger can obtain 2.0 to 3.0 mm extra length of the nail. The appearance of the transplant is improved without nail growth deformity. This is a simple and effective procedure.