手指末节或中末节缺损的修饰性再造与修复

Aesthetic reconstruction of distal finger or middle-distal finger degment with transplantation of 2nd, 3rd or 4th toe

目的报道采用第二、第三或第四趾移植对手指末节或中末节缺损进行修饰性再造与修复的疗效。方法根据供趾的外观，选择第二、第三或第四趾为供区，采用趾-指动、静脉吻合方式重建血液循环为108例手指末节或中、末节缺损的患者再造141指。对趾腹肥大或足趾中间节段较细的供趾-期进行外形重塑。结果本组共成活140指，成活率99．3％，其中，81例105指经1—10年（平均3．5年）随访。按中华手外科学会拇、手指再造功能评定试用标准，优61例，良16例，中4例，优良率为95．1％。结论对手指末节或中末节缺损的足趾移植再造，首选第二趾为供区；若第二趾外观较差，应灵活选用第三或第四趾移植；部分病例还需对足趾进行必要的外形重塑，以期获得修饰性再造的效果。

Objective To report the results of aesthetic reconstruction of distal finger or middle-distal finger segment with transplant harvested from 2nd, 3rd or 4th toe. Methods In a series of 108 cases of distal finger or middle-distal finger segment defect, 141 fingers were reconstructed with transplants harvested from 2nd, 3rd or 4th toe according to the outward appearance of donor toe. The blood-supply was restored by anastomosis of digital artery and vein. In first-stage reconstruction, refinement of outward appearance was applied in doner toe if the toe pulp is bulky or middle part of toe was relatively thinner. Results One hundred and forty fingers survived. The successful rate was 99.3%. Among them, 81 patients had been followed up from 1 to 10 years （mean 3.5years） postoperatively. 61 cases were graded to be excellent and 16 cases good as assessed with Criterion of Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery. Conclusion For aesthetic reconstruction of distal finger or middle-distal finger segment, the 2nd toe is usually considered to be donor of first choice. In case the outward appearance of 2nd toe was inferior to that of 3rd or 4th toe,the 3rd or 4th toe should be chosen for better result. In some cases, revisional aesthetic surgery were necessary to refine the outward appearance in first-stage reconstruction.