足趾移植重建小儿拇手指缺损的体会

Toe to thumb transfer for thumb defect reconstruction in children

目的介绍足趾移植重建小儿拇、手指缺损的治疗体会。方法2005年4月至2011年4月，采用足趾游离移植再造小儿拇、手指13例，其中移植躅趾末节重建拇指末节外伤性缺损2例，第二足趾移植重建外伤性拇指缺损5例，双足第二足趾移植重建外伤性手指多指缺损2例，重建先天性拇手指横向缺如1例，重建先天性手指多指缺如或发育不良3例。并对再造手指功能进行评定。结果术后随访16个月至5年，13例再造拇、手指全部顺利存活，再造指生长发育良好，恢复了良好的抓捏功能，两点分辨觉11～15mm。根据中华医学会手外科学会拇、手指再造功能评定试用标准评定：优9例，良4例。供足步态正常，无疼痛等不适，足部功能无明显影响。结论足趾游离移植重建小儿拇、手指缺损可获得满意的治疗效果。

Objective To report the experience of toe transplantation in thumb and finger reconstruction in children. Methods From April 2005 to April 2011, 13 cases of thumb or finger defects were treated with toe transplantation. Distal segment of the great toe was transferred in 2 patients with posttraumatic defects of distal part of the thumb. Second toe transplantation was performed in 5 patients with thumb defects. Bilateral second toe transfer was performed in 2 patients with posttraumatic defects of mtdtiple fingers, 1 patient with congenital transversal defect of the thumb, and 3 patients with congenital defects or dysplasia of fingers. Postoperative function of the reconstructed digits was evaluated. Results Postoperative follow-up period ranged from 16 months to 5 years. All the transplants in the 13 cases survived. Growth of the transplants was normal. The ability of grip was regained. Two-point discrimination was from 11 to 15 mm. According to the functional assessment criteria for thumb and finger reconstruction issued by the Hand Surgery Society of the Chinese Medical Association, the outcomes were excellent in 9 cases and good in 4 cases. There was no abnormal gait and pain in the donor foot. The function of the foot was not impaired. Conclusion The outcomes of toe transplantation in reconstruction of thumb and finger defects in children are satisfactory.