及第二趾皮瓣瓦合修复不同程度的手部皮肤脱套伤

Transfer of vascularized fibular pulp flap of the big toe combinded with wrap-around flap of the second toe to repair various degrees of degloving injury of the thumbs or fingers and hand

目的探讨及第二趾皮瓣瓦合修复拇、手指及全手脱套伤的临床应用。方法采用多种不同手术方法修复拇和手部脱套伤。①采用距甲瓣加第二趾胫侧皮瓣修复拇指脱套伤9例。②采用趾腓侧皮瓣加第二趾甲皮瓣修复手指16例22指。③采用双侧腓侧腹皮瓣加双侧第二趾甲皮瓣带足背皮瓣加足外侧皮瓣修复示、中、环指1例。④双侧第二趾甲皮瓣加双趾腓侧皮瓣加双足背皮瓣和股前外侧皮瓣修复手部脱套伤2例。⑤采用甲瓣加第二趾胫侧皮瓣瓦合再造拇指,带足背皮瓣覆盖手背,趾腓侧皮瓣与第二趾甲皮瓣瓦合再造手指带足背皮瓣覆盖手背和股前外侧皮瓣覆盖手掌创面3例。结果31例44指91块皮瓣中有一块坏死,经重新植皮后愈合,另1例组合移植中再造示指骨感染经切除指骨创口愈合,另1例拇指成勾甲,其余皮瓣全部成活。术后随访6个月以上共22例31指,29指除DIP关节外余关节活动接近正常,指甲生长尚好,外形接近正常,两点分辨觉5.0～12.0mm。供区足趾数不缺少,无明显功能影响。另一指因指骨感染切除骨而皮瓣成活。全手脱套伤中,手掌皮瓣两点分辨觉10.0～15.0mm。结论距趾腓侧皮瓣(或甲瓣)与第二趾甲皮瓣(或第二趾胫侧皮瓣)瓦合修复拇手指和全手脱套伤,功能好,外观满意,供区无明显功能影响,是治疗拇、手指和全手脱套伤较好的术式。

[ Objective] To explore the treatment outcome of using vascularized fibular pulp flap of the big toe combinded with wrap-around flap of the eecond toe to repair degloved injury of the thumbs or fingers and hand. [Methods] 44 degloved fingers in 31 cases were treated, of which the thumbs were 9 cases and the fingers were 22 in 16 cases. The thumbs defection were repaired by wrap-around flap of the big toes combinded with the pulp flap of the second toes; the fingers defection were repaired by pulp flap of the big toes eombinded with wrap-around flap of the second toes; 2 fingers in 1 case used fibular pulp flap of the big toe and wrap-around flap of the second toe eombinded with dorsalis pedis flap and lateral dorsalis pedis plap. 3 cases of all hand degloving injury were repaired with bi-nail flaps from second toes combined bi-pulp flaps from big toes and bi-pedaldorsal flaps and femoral anterolateral flap; 3 cases of all hand degloving injury was repaired with wrap-around flap of the big toe combined fibular sider flap of the second toe to reconstruct the thumb, and the pedaldorsal flap to cover the dorsum aspect of the hand, and fibular side flap of the big toe combined the second toe＇s nail flap to reconstruct the finger, and the femoral anterolateral flap to cover the defection of the plam of the hand. [Results] One flap of 91 flaps of 44 fingers in 31 cases were necrosis using skin graft in the second stage, the other were all survived. 31 fingers in 22 eases were followed up more than 6 months, the action of all joints approaching normal except DIP, the nail grew well and had a good appearance, the 2-PD were 5-12 mm. there were no complications in foots＇ function and had normal toe counts. [Conclusion] Vascularized fibular pulp flap（wrap-around flap） of the big toe combinded with wraparound flap （fibular sider flap） of the second toe was one of the best options to repair degloving injury of the thumb or finger and hand, the patients accepted.