第二趾甲皮瓣修复手指皮肤脱套伤术后随访报告

Long-term follow-up visit report of the second toenail flap in the repair and reconstruction of overall hand skin degloving injury

目的:报告第二趾甲皮瓣修复手指皮肤脱套伤术后的中长期随访结果。方法:对109例121指手指皮肤脱套伤,选用第二趾甲皮瓣或带足背皮瓣的第二趾甲皮瓣进行修复。对其中61例74指进行了2～8年(平均4年)的随访。结果:随访显示,修复后的手指外形良好,指甲生长良好,指腹饱满、指腹感觉恢复S2～S4,36指两点辨别觉达到4～7mm,65指手指屈曲功能接近正常,所有病例手指都能够完成写字、持物等动作,21指能够完成捡针的精细动作,足部供区出现并发症4例,其中2例出现两种不适的表现,并发症出现率6.5%。参照中华医学会手外科分会拇、手指再造功能评定试用标准结合足部供区情况进行评定,属优者45例52指,良者13例16指,可者3例6指,无差的病例,优良率95.1%。结论:第二趾甲皮瓣急诊修复手指皮肤脱套伤,修复的手指有指甲和丰满的指腹,可最大限度地恢复伤指的外形和功能。

Objective： To report the long-term follow-up visit results of the second toenail flap in the repair and reconstruction of overall hand skin degloving injury.Methods A total of 109 cases and 121 fingers of overall hand skin degloving injury patients have received the reconstruction by using the second toenail flap or dorsalis pedis flap for the repair and reconstruction.61 cases and 74 fingers were followed up for 2～8 years（4 years in average）.Results The follow-up visits showed that the appearance of hand was all right,the toenails grew well,the finger pulps were plump,the sensory recovery S2~S4 of reconstruction finger and flap was achieved,the two point discrimination of 36 fingers reached 4~7 mm,the flexion function of 65 fingers were near normal,all fingers could accomplish writing and holding objects tasks,21 fingers could accomplish fine movements of picking up needles,the donor area showed syndromes in 4 cases,among which 2 cases showed indisposition,the ratio of syndromes was 6.5%.According to the tentative standard of thumb and finger reconstruction function access of the hand surgical branch of Chinese Medical Association,combined with the status of the foot donor area,45 cases and 52 fingers were excellent,13 cases and 6 fingers were good,3 cases and 6 fingers were medium,no bad cases,the ratio of choiceness was 95.1%.Conclusion The application of the second toenail flap in emergent repair and reconstruction of overall hand skin degloving injury could restore the nails and plump pulps.It could reconstruct the appearance and function of injured fingers to the highest degree.