半趾甲瓣移植修复手指末节缺损

Half hallux toenail flap transplantation to repair the distal segment finger defect

目的探讨半躅趾甲瓣移植再造手指末节效果。方法通过对64例69指手指末节完全和部分缺损、末节皮肤撕脱、皮管术后整形、冉植失败等采用以第一跖底、跖背或趾动脉为蒂切取部分趾甲连同趾腹皮瓣或部分趾甲修复，根据供足创面大小采用第一跖背、第二趾动脉、腓动脉穿支、跖底动脉皮瓣覆盖，观察术后手指及足部供区外形。结果经随访3个月～4年，手指指腹饱满有弹性，趾、指甲床问愈合好，再造甲襞形成的甲沟略浅，外形逼真，感觉均恢复，两点辨别觉4—5mm，供足趾丰满，似原趾外形，患者对再造手指和足趾外形均满意。结论半蹰趾甲瓣是修复手指末节缺损的理想方法。

Objective To discuss the treatment of half hallux toenail flap transplantation for reconstruction of the distal segment finger defect. Methods Based on using the first plantar/dorsal metatarsal artery, or toe artery as pedicle to cut off partial toenail together with toe abdomen flap or partial toenail to repair 64 cases which include 69 fingers with distal segment complete and partial defect, the distal skin avulsion, skin tube in postoperative plastic, replantation failure and so on. Depending on the size of the donor foot wound use the first dorsal metatarsal artery, second toe artery, the perforating branch of peroneal artery or plantar metatarsal artery flap to cover the wound, and then observe the appearance of the finger and foot donor site after operation. Results The finger pulp was full and elastic, nail bed of the toe was well heal- ing, nail groove which originated from the reconstructed nail fold was shallow, the appearance was realistic, all feelings were recovery, two-point discrimination was 4 to 5 millimeter, the donor toe was plump like the original one in appearance, patients were all satisfied with the reconstructed finger and the toe shape, after a follow-up from 3 month to 4 years. Conclusion Half hallux toenail flap transplantation is an effective way to repair the distal segment finger defect.