第二、三趾联合局部转移皮瓣整形第二趾再造拇手指

Second toe plasty using local flap transfer from the 3rd toe in second toe-to-thumb/finger transfer

目的介绍以第二、三趾联合局部转移皮瓣整形第二趾再造拇、手指的新方法。方法对26例再造拇、手指的患者，利用第二跖背动脉或第二趾底总动脉在第三足趾发出的分支血管，设计局部转移皮瓣，将其嵌入第二趾中节的腓侧，以增加第二趾的周径；利用趾背动脉之间、趾背与趾足底动脉之间、趾足底动脉之间存在的吻合，设计趾腹皮瓣，将其嵌入第二趾跖侧，消除再造手指狭细的形态。将第二趾整形后，再移植于手部，再造拇、手指。结果26例38指，76块局部转移皮瓣全部存活，对供区第三趾血运无影响，再造手指外形非常满意。结论以第二、三趾局部转移皮瓣对第二趾整形，再进行拇、手指再造，此法是改善再造手指外形的良好方法。

Objective To introduce a new procedure for 2nd toe plasty by transferring local flap from the 3rd toe in 2nd toe-to-thumb/finger reconstruction. Methods In 26 cases of 2nd toe transfer to reconstruct the thumb or fingers, a flap from the 3rd toe based on an anastomosing branch from the 2nd dorsal metatarsal artery or the 2nd plantar metatarsal artery was harvested and insetted to the fibular side of the middle phalanx of the 2nd toe to increase the circumference of the transplant. A pulp flap was also designed based on the anastomosis between the dorsal digital arteries, between the dorsal and plantar arteries, or between the plantar arteries. It was transferred and insetted in the plantar aspect of the 2nd toe to eliminate middle stenesis. The pre-fabricated 2nd toe was transferred to reconstruct the thumb and fingers. Results All 76 flaps of 38 toe transfers in the 26 cases survived. There was no compromise of the blood circulation to the 3rd toe. The appearance of the reconstructed finger was satisfying. Conclusion Transfer of local flap from the 3rd toe in 2nd toe-to-thumb/finger reconstruction can improve the appearance of the 2nd toe transplant and is thus a good procedure.