一期再造正常长度手指的实验与临床应用

Experiment and clinical application of one stage reconstruction of whole-length finger with three phalange

目的 探索一期再造全长手指的手术设计和技术。 方法 手指中远节选用足趾或甲瓣再造 ,近节尝试不同形式再造 ,以复合或联合移植方式一期合成全长指。设计修复全长手指脱套伤和再造缺失全长指的术式各两种 ,在猴模型进行实验 ,每种术式实施 6例次。临床应用带跖骨和足背皮瓣的甲瓣修复示指全长脱套伤 1例 ;带跖趾背皮瓣和跖骨的第二趾移植再造缺失的全长中指 1例 ;第二趾和肘外侧皮瓣联合移植再造全长示指 1例。 结果 猴全长指再造近期存活率平均 91.7% ,远期存活率平均 37.5 % ,猴自残和制动不当是影响存活率的最主要因素。临床再造 3例全长指均完全存活 ,恢复良好外观和部分实用功能。 结论 再造全长指方法的可行 ,有一定临床应用价值 ,但需设法提成功率 ,再造指的外观仍需进一步改善。

Objective To explore the operative designs and techniques of one stage reconstruction of whole-length finger with three phalange Methods The free toe or wrap-round flap of big toe was selected to reconstruct both distal and middle phalange of the lost finger,the proximal phalanx was reconstructed by using different ways,then a whole-length finger was integrated by using composite tissue flap transplantation or combined transplantation of various tissue flapsTwo plans for reconstruction of whole-length finger loss and two plans for repair of the degloved avulsion of whole-length finger were designed and used in the monkey model,and each method was performed in 6 experimental casesThe loss of a whole-length index finger,degloved avulsion of a whole-length index finger,and the loss of a whole-length middle finger were reconstructed in 3 clinical cases by different operative methods Results The recent survival rate of the reconstructed finger was 917%(22/24),and late survival rate was 375%(9/24) in the monkey modelThree reconstructed whole-length fingers survived in the 3 clinical cases,and the appearance of the reconstructed fingers was good,the function of the injured hands are recovered well Conclusions The methods for reconstruction of whole-length finger are available and valuable in this series,but the cosmetic outcome of the reconstructed finger and the operative reliability need to be improved