拇指指尖部再造的临床体会

CLINICAL EXPERIENCE IN THUMB FINGER-TIP RECONSTRUCTION

目的探讨拇指指尖部缺损的临床修复效果。方法根据拇指指尖部缺损情况,采用第二足趾末节游离移植再造拇指指尖指甲1/2以远伴骨缺损8例。采用同侧趾甲皮瓣再造拇指指尖部伴指腹或指甲缺损、骨外露6例。结果再造拇指指尖14例14指全部成活。随访3个月～2.5年,再造指指腹外观饱满,质地、颜色与手指掌侧皮肤相似,两点分辨觉在4～6mm,拇手指在对捏、持物时无疼痛及感觉过敏,外形、功能满意。足部供区愈合好,无痛、未见明显瘢痕及胼胝体形成,行走无影响。结论应用第二足趾末节或甲皮瓣再造拇指指尖,具有外形美观,功能恢复佳,手术方法简单,成功率高,可满足患者心理需求等优点。

Objective To explore the clinical effect of repairing the defect of thumb finger - tip region. Methods According to the defective condition of thumb finger - tip region, 8 cases thumb finger nail distal 1/2 with bone defect were reconstructed through adopting the second toe paratelum free grafting. 6 cases of thumb finger - tip defect accompany finger pulp or finger nail defect meanwhile bone reveal were reconstructed by homolateral big toe wrap - around flap. Results All reconstructed thumbs of 14 hands in 14 cases survived. Followed 3 months to 30 months, the shape, texture, and color of reconstructed finger pulp resembled contrast palm skin. And tactile discrimination was from 4 - 6 mm, besides the shape and sensory function were satisfactory. The donor site of foot healing was well, without pain, non - emerges scar or callosity, having no side effect on walking. Conclusion Application of the second toe paratelum or big toe wrap - around flap to reconstruct the thumb finger - tip have many advantages such as beautiful outlook, excellent functional rehabilitation, simple operative method, high ratio of success, satisfied psych -demand and so on.