游离第二趾肌腱皮瓣修复手指复合组织缺损

Application of Free Second Toe Flap for Repair of Finger Tendon Composite Tissue Defect

目的探讨带趾伸肌腱的第二趾皮瓣修复手指复合组织缺损的临床疗效。方法采用游离带趾伸肌腱的第二趾皮瓣修复伴有肌腱缺损的手指复合组织缺损21例(25指)。结果本组皮瓣均成活,供区植皮一期成活24趾,1趾植皮部分坏死,经换药后愈合。术后,患者进行理疗和功能锻炼,随访6～22个月(平均12个月),皮瓣无明显萎缩及色素沉着,感觉恢复2-PD6～12mm,手指外形满意,修复指关节屈伸活动恢复满意,按照肌腱修复后TAM/TPM标准评价,属优者8指、良12指、可3例、差2例,优良率80%,临床效果满意。结论带趾伸肌腱的第二趾皮瓣修复伴有肌腱缺损的手指创面,可一次完成皮肤、肌腱的缺损修复,是一种较好的方法。

Objective To explore the clinical efficacy of the application of the second toe flap with extensor tendon in the repair and reconstruction of composite tissue defects of the fingers. Methods A total of 21 cases and 25 fingers with tendon damaged were reconstructed with the second toe flap of extensor tendon. Results All of the flaps survived, the donor area recovered by first intention in 24 toes, for one toe the planted area were partly affected by necrosis, it healed after medicine change. After 6-18 months follow up, with an average of 12 months, the flap survived well without atrophy or pigmentation. The sensor recovered at 2-PD 6-12 mm. The appearance of the fingers was good and the flection function of the injured fingers recovered satisfactorily. According to the TAM/TAF standard, 8 cases were excellent, 12 cases were good, 3.case were medium, 2 cases were bad. The excellent and good rate was 80% （excellent in 8 cases, good in 12 cases）. The clinical efficacy was satisfactory. Conclusion The application of the second toe flap with extensor tendon in the repair and reconstruction of finger tendon composite tissue defect was proved to be a good method, with the advantage of reconstruct both the skin and the muscle tendon in one stage operation.