急诊游离趾甲皮瓣修复或重建拇指

Primary thumb reconstruction by free wrap around flap transfer from the big toe

目的探讨急诊应用游离趾甲皮瓣修复或重建拇指的最佳适应证。方法对１２例拇指脱套伤和４例无再植条件的拇指离断伤，彻底清创后，采用游离趾甲皮瓣修复或重建拇指。术中发现，第一跖骨背动脉均系ＧｉｌｂｅｒｔⅢ型，选择足背动脉为动脉蒂，大隐静脉为静脉蒂。结果１６例重建拇指全部成活。创面Ⅰ期愈合１５例，１例末节皮缘局部坏死，经换药后愈合。术后随访６个月～１２年，重建拇指的感觉和运动功能恢复良好。结论不能再植的拇指缺失或拇指皮肤脱套伤，是急诊应用游离趾甲皮瓣移植的最佳适应证。

Objective To investigate the best indications for primary thumb reconstruction by free wrap around flap transfer from the big toe. Methods 12 degloving thumbs and 4 severed thumbs un favorable for replantation were primarily reconstructed by transplantation of wrap around flap from the big toe. During debridement, all digital arteries were found to be belonged to Gilbert type . The blood circulation of the transplant was restablished by anastomosis of the first dorsal digital artery to the radial artery and the greater saphenous vein to the veins of the recipient area.All patients were followed for 6 months to twelve years. Results All reconstructed thumbs survived. Primary healing of the wound was found in 15 cases. In 1 case, there was skin necrosis of the distal part and the wound healed after dress changing. The sensory and motor function of the thumbs was satisfactory. Conclusions Either degloving thumbs or severed thumbs unfavorable for replantation were best indications for primary thumb reconstruction by wrap around flap transfer from the big toe.