游离足趾移植再造手指

Free toe transplantation for finger reconstruction

目的探讨游离足趾移植再造手指的疗效。方法对164例（185指）手指缺损患者行足趾移植再造手指，其中男134例（135指），女30例（50指）；年龄12～83岁[（44．8±11．2）岁]。根据缺损程度分类：Ⅰ度1例，Ⅱ度18例，Ⅲ度23例，Ⅳ度49例，V度54例，Ⅵ度19例。跖背动脉分型采用Gilbert分型：Ⅰ型68例，Ⅱ型84例，Ⅲ型12例。观察移植指存活及手功能恢复情况。结果移植指存活160例（173指），失败4例（12指）。存活160例中缺损程度Ⅰ～Ⅴ度均全部存活，Ⅵ度存活15例；Ⅰ型68例全部移植成功，Ⅱ型成功83例，Ⅲ型成功9例。4例（12指）失败患者中跖背动脉Ⅱ型1例，Ⅲ型3例，缺损程度均为Ⅵ度。术后手功能评定优110例，良50例。结论足趾移植冉造手指可恢复缺损手指的外形及功能，疗效满意，跖背动脉的解剖变异是导致再造失败的主要原因。

Objective To investigate the effect of free toe transplantation in finger reconstruc- tion. Methods Free toe transplantations were performed in 164 patients （ 185 fingers） suffering from finger defection. There were 134 males and 30 females, aged at 12-83 years [mean （44.8 ± 11. 2） years]. Finger deletion severity was classified as grade I in one case, grade Ⅱ in 18, grade m in 23, grade Ⅳ in 49, gradeⅤ in 54, and grade VI in 19. According to Gilbert standards, dorsal metatarsal ar- teries were classified as type Ⅰ in 68 cases, type Ⅰ in 84, and type Ⅲ in 12. Survival ratio of the trans- planted fingers and hand function rehabilitation were observed. Results The transplanted toe survived in 160 cases （ 173 fingers）. They composed of all the cases of grade Ⅰ -Ⅴ finger deletion and 15 cases of grade VI finger deletion; all the cases of type I dorsal metatarsal arteries, 83 cases of type Ⅱ dorsal metatarsal arteries and nine case of type Ⅲ dorsal metatarsal arteries. Transplantation failed in four cases （ 12 fingers） of grade Ⅵ finger defection including one case of Gilbert Ⅱ dorsal metatarsal arteries and three cases of Gilbert Ⅱ dorsal metatarsal arteries. Postoperative results were excellent in 110 cases and good in 50. Conclusions Toe transplantation is helpful to restore the finger shape and function and the outcome is satisfactory. Anatomic deformation of dorsal metatarsal arteries is the main cause for the failure of finger reconstruction.