足背动脉移植手指再造与其解剖变异

Dorsal petal artery transplantation for finger reconstruction and its anatomic variation

背景:以足背动脉为血供的第二足趾和拇甲瓣移植再造手指在临床有广泛的应用,但有的患者足背动脉出现解剖变异,给手术过程带来了困难,第2套供血系统的发现——第一跖底动脉和第二趾背动脉解决了这一问题。目的:分析游离第二足趾移植拇甲瓣移植手指再造及其足背动脉变异的临床意义。方法:游离第二足趾及拇甲瓣再造拇指15例,术中运用第2套供血系统——第一跖底动脉和第二趾背动脉。功能评估参照中华医学会手外科学会拇手指再造功能评定试用标准(2005-3-25),由患者根据再造拇指长度、外形、功能及感觉的恢复情况进行评估。结果与结论:再造拇指全部成活,无移植并发症,随访5个月～2年,再造拇指功能恢复好,长度合适,感觉恢复好,按手外科学会再造指功能评定标准,优良率93%,外形满意,复查供趾足,外形尚好,步态平稳,步行无疼痛。提示充分做好移植前准备,术中无创操作,移植后仔细观察,熟悉足部解剖特别是足背动脉变异,以及第2套供血系统的解剖是确保拇指再造成功的关键。

BACKGROUND：The second toe and toe-nail flap with dorsal petal artery as blood supply for finger reconstruction have been widely practiced in clinic.However, there is a difficulty in the process of operation since anatomic variation of dorsal petal artery happens to some patients.The second set of blood supply system-the first dorsal metatarsal artery and the second dorsal petal artery-provides a solution to the problem.OBJECTIVE：To explore the clinical significance of free second toe or toe-nail flap transplantation for finger reconstruction and dorsal petal artery variation.METHODS：The free second toe or toe-nail flap transplantation for thumb reconstructon were performed in 15 cases, and the second blood supply system was adopted-the first dorsal metatarsal artery and the second dorsal petal artery.According to the probational standard （2005-3-25） issued by the Chinese Medical Association for surgery of the hand, patients evaluated reconstructed thumb function themselves considering the length, shape, function, and feeling recovery of the thumb.RESULTS AND CONCLUSION：The reconstructed thumbs all survived without complications.All patients were followed up for 5 months to 2 years, and the excellent rate was 93% as the function was well recovered, length was suitable, and recovering feeling was good.Reexamination of the donor foot showed that its outline was still good and patients could reposefully walk without pain.The key to the success of thumb reconstruction is a good job for preoperative preparation, intra-operative non-invasive operation followed by careful observation, familiar with the foot anatomy, especially the dorsal petal artery variation and the anatomy in the second set of blood supply system.