双（母）趾甲骨皮瓣拼合法再造手指

Finger reconstruction： combined flap constituted of bilateral hallux nails, skins and bones

目的 探讨双侧（母）趾甲骨皮瓣拼合移植再造手指的方法及效果.方法 在双侧（母）趾各 切取半侧（母）趾甲骨皮瓣,再将两个半侧（母）趾甲骨皮瓣拼合成手指外形后移植于残指残端,再造缺损的部分手指.（母）趾甲骨皮瓣供区采用跖底皮瓣或足部其他皮瓣移位修复.2003年6月至2009年6月,应用该方法再造手指20例20指,缺损程度为Ⅰ°～Ⅲ°.结果 20例再造手指全部成活,术后随访1～5年,再造手指外形近似正常手指,再造拇指掌指关节与腕掌关节活动范围正常,再造手指总活动度平均为203°,感觉功能S3以上,两点辨别觉在6～10mm.双侧（母）趾保留了大部分的趾甲,外形美观对称.修复（母）趾甲骨皮瓣供区的皮瓣全部存活,供足无疼痛,无磨损或破溃,步态正常.结论 双侧（母）趾甲骨皮瓣拼合移植法再造手指,外形美观,对供区（母）趾功能与外形的破坏小.

Objective To report our usage of a combined flap which is constituted of bilateral hallux nails, skins, bones to reconstruct a finger, and to introduce the method and outcome of this way. Methods Combine two halves of halluxes harvested from both feet to reform a fabricated finger and then transplant it to the finger stump to reconstruct the defect part of the finger. Plantar flaps or some other flaps near the donor sites were transposed to cover them. From June 2003 to June 2009, a total of 20 fingers （20 cases） which had defect degrees range from I to Ⅲ underwent reconstruction surgeries in this way. Results All the 20 fingers transplanted survived completely. Follow-ups 1 to 5 years after each surgery： all the fabricated fingers had very realistic configurations. The MP joints of the reconstructed thrumbs got to the normal range of motion, and the other reconstructed fingers＇ total ROM were 203 degree on average. All the reconstructed fingers had the sensation function above S3,and their two-point discriminations ranged from 6mm to 10mm. Both halluxes of each case were conserved major parts of nails and had nice, symmetric appearances. All the flaps for the donor halluxes survived completely, and none of the cases showed pains, ulcers or abrasions of their feet. All the cases showed normal gaits during follow-ups. Conclusion The combined flap by bilateral hallux nails, skins, bones is an ideal alteration for finger defect reconstruction for the important advantages of realistic configuration as well as minor destructions to donor sites.