趾背甲皮瓣并髂骨移植修复拇、手指组织缺损

Repair of tissue defects on thumb and fingers with dorsal nail-skin flap of toe and autogenous iliac bone transplantation

目的探讨趾背甲皮瓣并自体髂骨移植修复拇、手指中末节背侧复合组织缺损的手术方法及临床疗效。方法对11例13指拇、手指中末节背侧复合组织缺损患者，应用游离拇趾背、第2趾背甲皮瓣并移植自体髂骨进行修复；应用游离拇趾背、第2趾背甲皮瓣修复拇、手指中末节背侧皮肤及指甲的缺损，移植自体髂骨修复中末节指骨的缺损，足部供区自髂腹部取全厚皮片植皮。结果移植后的皮瓣及指甲全部成活，切口均I期愈合；足部供区植皮顺利成活，髂腹部供区切口I期愈合。随访6—36个月，移植后的指甲外形、手指触觉满意，指甲生长速度接近正常。参照ZOOK指甲评定标准评定：优者8指，良者5指，优良率100％。指背皮瓣无臃肿，移植髂骨与指骨达到骨性愈合，未出现骨不连、骨质吸收的情况。除5例关节融合者远侧指间关节无活动度外，其余8指远侧指间关节活动度为0—60°，足供区植皮愈合良好，无瘢痕挛缩及植皮区破溃，足功能无明显影响。结论应用趾背甲皮瓣并自体髂骨移植修复拇、手指中末节复合组织缺损可以最大程度地恢复手指的外形及功能，是修复此类损伤的理想方法。

Objective To explore the operative method and clinical effect of dorsal composite tissue defect of thumb and fingers repaired with dorsal nail-skin flap of toe and autogenous iliac bone transplantation, neth otis Eleven patients with 13 dorsal composite tissue defects of thumb and fingers were repaired with free dorsal nail-skin flaps from big toe and nail-skin flaps of the second toe and the autogenous iliac bone transplantation ： the free dorsal flaps from big toe and nail-skin flap of the second toe were used for repairing the dorsal skin and the unguinal defects located on the middle and distal end of thumb and fingers; the autogenous iliac bone transplantation was adopted for repairing the bony defects of distal phalanx and the defects on donor site which were grafted with full thickness skin graft taken from the pars ilica and abdomen. Results All grafted flaps survived well and the wound healed primarily. Follow-up was performed for 6 -36 months （mean 15 months）, transplanted fingers and nails were with good shape, satisfactory sense of touch and normal growth velocity. According to the ZOOK nail evaluation criteria： the excellent results were received in 8 cases, good in 5 cases （the excellent and good rate was 100% ）. All patients were satisfied with bone union of grafted iliac bone and finger bones without swollen finger dorsal flaps, bone nonunion and bone resorption except for 5 cases with distal interphalangeal joint inanimation because of joint fusion, while the other 8 cases with 0 - 60° motion of joint. Grafted skin on donate site healed well without scar contracture and ulcerate. There was no influence on foot function. Conclusion Application of dorsal nail-skin flap of toe and autogenous iliac bone transplantation in repairing the composite tissue defects located on the middle and distal end of thumb and fingers can furthest recover the fingers＇ shape and function. It is an ideal method for repairing this kind of injure.