应用伤指残存的邮票样断层甲床移植一期修复甲床缺损

Repairing nail bed defect in firet stage by stamp-like nail bed transplantation from injured finger

目的探讨利用伤指健存甲床的邮票样断层移植一期修复甲床缺损的临床疗效。方法对18例21指甲床缺损面积40％－80％的患者，采用在伤指健存甲床上切取中厚断层甲片，于手术放大镜下分割成2．0mm×2．0mm的小甲片若干．将其以1～2mm的间隔邮票样植皮均匀平整覆盖至甲床缺损区修复甲床缺损．术后打包加压固定．2周拆线。结果2指术后拆线时出现移植甲床的点状坏死，经换药后愈合；余19指移植甲床均一期成活。术后16例18指随访10-24个月，根据吕桂欣等方法进行疗效评定，优12指，良3指，差3指，优良率83．3％。结论利用伤指健存甲床的邮票样断层移植一期修复甲床的大部分缺损，手术操作简单，易于推广。

Objective To explore the clinical efficacy of repairing finger nail bed defects by stamp-like nail bed transplantation from injured finger in one stage. Methods 21 fingers of 18 patients with nail bed defect area from 40% to 80%, were repaired by middle thickness grafts of nail bed harvested from the residual nail beds of the same fingers. The residual nail beds were divided into small bits of 2.0 mmX2.0 mm, and symmetrically transplanted to the defect area of nail bed. The finger were packaged and pressurized fixed postoperative, and then stitches defused after 2 weeks. Results Spotty necrosis were seen in the transplanted nail bed of 2 fingers, but healed after changing dressing, other 19 transtplanted nail bed survived. 18 fingers of 16 patients got follow-up from 10 to 24 months, the effect was evaluated according to the method of GuiXin Lv, excellent and good rates were 83.3%, excellent in 12 fingers, good in 3 fingers, poor in 3 fingers. Conclusion The transplantation of residual stamp-like nail bed to repair nail bed defect in first stage, is easy to operate and to spread.