双足趾与第2趾甲皮瓣联合一期修复多手指脱套伤

Combined bilateral toe flaps for repair of the multi-finger degloving injury at one stage

[目的]探讨双足趾腓侧皮瓣与第2趾甲皮瓣瓦合修复多个手指脱套伤的临床应用。[方法]采用多种不同手术方法修复多个手指脱套伤,双足部分甲瓣和第2趾胫侧皮瓣修复手指3例6指。双足第2趾甲瓣和趾腓侧皮瓣修复手指17例37指。双足部分甲瓣和双足第2趾甲瓣加股前外侧皮瓣修复手指1例4指。[结果]21例47指98块皮瓣,其中有一块皮瓣坏死,97块皮瓣全部成活,随访17例37指,随访时间6～9个月,平均8个月。36指指间关节活动均接近正常,33指指甲生长完好,外形接近正常,手指两点辨别觉5～11mm,供区功能基本无影响。[结论]双足趾腓侧皮瓣(或部分趾甲瓣)与第2趾甲瓣(或第2趾胫侧皮瓣)一期组合瓦合修复是多个手指脱套伤较好的选择。

[ Objective]To inrestigate the clinical outcomes of using bilateral tibial flap of the second toe nail flap combined with the fibulal flap of the big toe to repair the multi-finger degloving injury. [ Method] A variety of different methods were used to repair the multi-finger degloving injury, six fingers in 3 cases were repaired by partial bilateral wrap-around flaps combined with the tibial flap of the second toe. Sixteen fingers in 8 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe. Six fingers in 2 cases were repaired by bilateral second toenail flap, the flbulal flap of the big toe and the digital arterial island flap. Three fingers in 1 case were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe and the the lateral flap of dorsum of foot. Six fingers in 3 cases were repaired by bilateral second toe nail flap and the fibulal flap of the big toe and bilateral dorsum flap of foot. Four fingers in 1 case were repaired by partial bilateral wrap-around flaps and the tibial flap of the second toe and the anterolateral thigh flap. Six fingers in 3 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe, and bilateral dorsum flap of foot and bilateral anterolateral thigh flap. [ Result] Ninety-seven flaps of 98 flaps of 47 fingers in 21 cases were suvived well,with 1 flap developed necrosis. The follow-up duration ranged from 6 months to 9 years in 17 cases （37 fingers）. In addition to the activities of DIP limited,the other interphalangeal joint activities were nearly normal. All of the fingernail grew well. Two point discrimination of the fingers was between 5mm and 11 mm. The donor site was hardly affected. [ Conclusion] It is a better method using the big toe flap combined with the second toe flap to repair the the multi-finger degloving injury at one stage.