28例急诊足拇趾甲皮瓣移植再造拇指的临床体会

Clinical Experience of 28 Cases Emergency Hallux Toe-nail Flap Transplantation for the Thumb Reconstruction

目的:通过观察28例急诊足拇趾甲皮瓣移植再造拇指术的疗效,探讨该术式的特点和经验。方法:采取急诊足拇趾甲皮瓣移植再造拇指的方法,为28例拇指不同程度受伤的患者进行拇指再植术,术前做好手术区护理,术中注意拇指骨架的重建、血管的连接以及创面的修整,术后避免并发症。结果:28例患者术后皮瓣均能够成活,其中有1例1d后出现血管危象,抗痉挛治疗后缓解,1例出现拇趾端感染,经换药抗感染后恢复,2例供区植皮出现小部分坏死,经处理后创面愈合。28例患者经过1-3年随访,20例术后恢复良好,均有良好的感觉和运动功能,其余8例的功能恢复能基本满足患者的日常工作生活需求。结论:及时利用带甲皮瓣足拇趾施行拇指再造术是十分重要的,能够尽可能保留患者的拇指功能,同时不影响外观,极大地减少了拇指受损对患者的工作生活所造成严重影响。

Objective： To observe the effect of 28 cases emergency hallux toe-nail flap transplantation for the thumb reconstruction,and discuss the characteristics and experience. Method： By using the emergency hallux toe-nail flap transplantation to replant the thumbs of 28 patients,whose thumbs have suffered from various injuries.Good nursing care should be taken for the operation area preoperatively.During the operation,pay attention to the reconstruction of the thumb skeleton,vascular connections and wound dressing.Avoid complication after surgery. Result： Flaps in 28 cases survived after the surgery.Vascular crisis only occurred in one case the next day,and eased with antispasmodic therapy.Infection in the toe end occurred in another case,and recovered after dressing change and resistant therapy to infection.2 cases had small partial necrosis in the donor skin grafts,but the wound was healed after treatment.After 1 to 3 years＇ follow-up study,it is evident that 20 cases recovered well after surgery,with good sensory and motorial function.Functional recovery in other 8 cases can also meet the basic needs of patients＇ daily work and living. Conclusion： Reconstructing the thumbs with hallux toe-nail flap transplantation timely,which can reserve the thumb function to the utmost extent without influencing its appearance at the same time,reduces the negative effect of the thumb injuries on the patients＇ work and living.