游离第二足趾胫侧皮瓣修复手指指腹缺损

Reconstruction of finger pulp defects by the second toe tibial skin flap

目的报告应用游离第二足趾胫侧皮瓣移植修复手指指腹缺损的手术方法和临床效果。方法对70例76指手指指腹缺损的患者，采用游离第二足趾胫侧皮瓣进行修复，皮瓣切取面积为1．5cm×1．0cm-4．0cm×2．5cm。皮瓣的供血动脉采用第二足趾胫侧趾底固有动脉60指，采用第一跖背动脉一趾背动脉供血16指。足部供区采用全厚皮片加压植皮。结果70例76指皮瓣全部存活，其中4指皮瓣在术后3d内发生动脉危象，经手术探查后动脉危象解除。所有患者经过5—24个月（平均8个月）的随访，皮瓣质地、外形满意，手指功能恢复优良，远侧指间关节活动度为0°～60°，皮瓣两点分辨觉为4—9mm。足部供区创面Ⅰ期愈合71趾，植皮中央区部分坏死5趾，经换药后愈合。远期随访植皮区耐磨，不妨碍行走，无破溃发生。结论应用游离第二足趾胫侧皮瓣修复手指指腹缺损，具有手术操作相对简单、手术时间短、修复后的手指指腹饱满且外形逼真等优点，是一种理想的方法。

Objective To report the surgery procedure and treatment effect of reconstruction of finger pulp defects by the second toe tibial skin flap. Methods Seventy patients with pulp defects of 76 fingers were treated by the second toe tibial skin flap. The sizes of skin flap varied from 1.5 cm ×1.0 cm to 4.0 cm × 2.5 cm. The skin flap＇s feeding arteries were tibial plantar digital proper artery of the second toe, in 60 fingers and first dorsal metatarsal artery in 16 fingers. Donor site defect was covered by full thickness skin graft. Results Seventy- six fingers in 70 cases all survived. Arterial crisis occurred in 4 fingers within three days postoperatively, which was reversed by surgical exploration. All cases were followed from 5 months to 24 months with an average of 8 months. The flaps had satisfactory texture and shape. Good function recovery of the fingers was also achieved. The motion of distal interphalangeal joints ranged from 0 to 60 degrees, 2-PD reached 4 ram to 9 ram. Primary healing occurred in 71 toes ; necrosis in central part of the skin graft occurred in 5 toes, which healed through changing of dressing. Long-term follow-up revealed that the skin graft was durable. It did not disturb walking and was free of ulceration. Condusion Second toe tibial skin flap is an ideal method to reconstruct finger pulp defects. The surgery is relatively simple with reasonable operation time. The reconstructed pulp is full with a near normal appearance.