足部游离组织瓣移植修复手部相应组织缺损的疗效

Treatment outcome of tissue flap transplantation from the foot for repairing defect of the hand

目的 总结足部组织瓣移植修复手部相应组织缺损的临床效果。方法 应用足部游离组织瓣 (9种类型 )移植修复手部组织缺损 131例。 (1)拇及手指缺损 71例 :用第二足趾移植 42例 ,甲皮瓣 2 6例 ,部分第二足趾移植 3例再造手指、拇指 ;(2 )手背及手掌皮肤缺损及虎口挛缩 43例 :应用足背皮瓣 12例 ,足底内侧皮瓣 7例 ,趾腹皮瓣 6例及第二趾蹼皮瓣 18例修复皮肤缺损并开大虎口 ;(3)掌骨或掌指关节缺损 17例 :选用第一跖趾关节皮瓣修复 12例 ,第二跖骨皮瓣修复 5例。结果 6例失败 ,12 5例组织瓣成活 ,成活率为 95 .3 %。手部功能恢复较为满意 ,10例足部供区出现瘢痕不愈或步行时疼痛等并发症。结论 选择足部相应部位组织瓣修复手部组织缺损 ,特别是复合性组织缺损 ,效果满意。

Objective To evaluate the clinical effect of repairing tissue defect of the hand by transplantation of corresponding structures from the foot. Methods 9 types of tissue flap from the foot were transplanted for 131 cases of various tissue defect of the hand. (1) 71 cases of thumb and finger defect were repaired by second toe transfer (42 cases), wrap-around flap (26 cases), and partial second toe transfer (3 cases). (2) 43 cases of skin defect of the palm or dorsal aspect of the hand and the first web contracture were covered by dorsalis pedis flap (12 cases), medial plantar flap (7 cases), plantar flap of the big toe (6 cases), and the first web flap (18 cases). (3) 17 cases of metacarpol bone or metacarpophalangeal joint defect were treated with the first metatarsophalangeal joint flap (12 cases) and the second metatarsal osteocutaneous flap (5 cases ). Results 125 transplants survived while 6 failed with survival rate of 95.3 %. Satisfactory restoration of hand function was achieved. There were skin ulcer and pain on the donor foot in 10 cases. Conclusions Transplantation of the corresponding structures from the foot results in satisfactory repair of the hand defects ,especially composite tissue defect. However, there exists incidence of failure and impairment of donor foot function.