同血管蒂的双皮瓣改形第二足趾移植再造拇手指

Transfer of the second toe with double flaps based on the same vascular pedicle for reconstruction of thumb and fingers

目的报告应用双皮瓣改形的第二足趾移植再造拇、手指的方法。方法对16例19指拇、手指缺损的患者，应用第二趾趾腹胫侧趾动脉皮瓣和蹲趾腓侧皮瓣改形第二足趾移植再造拇、手指。结果16例19指再造拇、手指及用于改形的双皮瓣全部存活，术后随访时间为6～17个月，按中华医学会手外科学会上肢部分功能评定试用标准评定：优16指，良3指，优良率为100％。结论应用第二趾胫侧趾动脉皮瓣和躅趾腓侧皮瓣改形的第二足趾移植再造拇、手指，外形更接近正常拇、手指，方法可行，疗效可靠。

Objective To report the techniques of transfer of the second toe with double flaps based on the same vascular pedicle for reconstruction of thumb and fingers. Methods Nineteen defects of the thumb and fingers in 16 patients were treated with this procedure. The second toe was transferred along with tibial digital artery flap from the second toe pulp and fibular flap from the big toe. Results Nineteen reconstructed digits in 16 patients all survived. There was no flap loss. Follow-up duration raged from 6 to 17 months. According to the evaluation criteria for finger replantafion and reconstruction issued by Hand Surgery Society of Chinese Medical Association, results of 16 fingers were graded as excellent while the results of 3 cases were fair. The overall satisfactory rate was 100%. Conclusion Thumb and finger defects can be reconstructed using second toe double flap transfer with tibial digital artery flap from the second toe pulp and fibular flap from the big toe based on the same toe artery. The appearance of the reconstructed thumb and fingers is more comparable to the normal digits. It is a practical procedure that leads to reliable results.