小型游离足趾皮瓣修复拇手指组织缺损

Small size toe flap repair tissue defect of thumb and finger

目的报道应用游离足趾皮瓣移植修复拇手指皮肤及复合组织缺损的临床疗效。方法采用在足趾上切取6种类型小型游离皮瓣：足趾背侧甲瓣、足趾半侧甲瓣、足趾趾腹皮瓣、[足母]趾C形皮瓣、足趾背侧皮瓣、超长[足母]趾及第二趾趾蹼皮瓣，移植修复拇手指皮肤及复合组织缺损。结果83例皮瓣中81例全部成活。术后随访3～48个月，足趾背侧甲瓣全部成活，痛温触觉恢复，外形十分满意。足趾半侧甲瓣全部成活，痛温触觉恢复，外形满意。足趾趾腹皮瓣2例皮瓣坏死后行带蒂皮瓣修复，其余皮瓣全部成活。随访痛温觉恢复，两点分瓣觉恢复在4～6mm并能出汗，指腹饱满．具有罗纹。[足母]趾C形皮瓣全部成活，痛温觉恢复，两点分辨觉恢复在4～6mm。皮瓣质地类似原位手指皮肤。足趾背侧皮瓣全部成活，皮瓣色泽与受指接近，质地外形佳。超长[足母]趾及第二趾趾蹼皮瓣全部成活，虎口及拇示指皮瓣，质地外形佳，两点分瓣觉恢复在6～8mm。足部供区行走正常，无疼痛。结论应用游离足趾皮瓣移植是修复拇手指皮肤及复合组织缺损的一种较好的治疗方法。

Objective To explore small size toe tissue flap for aesthetic reconstruction of the thumb and / or finger. Methods Six kinds of small size toe tissue transplants had been applied in repairing skin-bone-joint composite tissue defects of the thumb or finger in 74 cases. Results Among 83 reconstructed flaps of the 74 patients, 81 flaps survived completely. Follow-up examination made three to forty-eight months postoperatively showed that the outward appearance were excellent in most cases. The function of the thumbs or fingers were good. The donor feet can walk normally with no pain. Conclusion A variable combinations of toe tissues including skin, soft tissue, bone and joint can be harvested to form a lot of small size transplants for refined aesthetic reconstruction of thumb and finger. The functional and aesthetic results are good and the treatment course is shortened.