拇指、手指Ⅰ、Ⅱ度缺损的再造

Reconstruction of Ⅰand Ⅱ degree defect of thumb and finger

目的应用部分足趾组织移植进行指-趾动脉吻合的拇指、手指Ⅰ度及Ⅱ度缺损再造。方法拇指、手指末节及指尖缺损65例71指,包括拇指49指,示指12指,中指5指,环指5指。其中6例为二指同时再造。拇指再造病例中,应用部分趾组织移植者14指,部分第二足趾组织移植者35指;手指再造全部应用部分第二足趾组织移植。结果术后发生动脉危象10指、静脉危象4指,经手术和药物治疗全部成活。20指行二期整形。38例42指得到随访,随访时间为6个月～13年。患者对再造指外形感到满意,能作指腹捏夹动作,感觉恢复到S3+以上者34指,其中30指的两点辨别觉达到6～8mm。供区无并发症。结论部分足趾组织移植进行指-趾动脉吻合的拇指、手指末节及指尖再造手术不受解剖异常的影响,术后的拇指、手指功能与外形比较符合患者的期望。

Objective To describe the method and review the outcome of reconstruction ofⅠandⅡdegree defect of thumb and finger by p artial transplantation of distal to e tissue from the great and /or second toe.Methods A series of 65cases with 71ⅠandⅡdegree thumb and finger defect were r econstructed.Of those,49were thumb defect,12index finger,5middle finger and 5ring fin ger.In 6cases,two digits were reconstructed simultaneously at th e same setting.For thumb reconstruction,the donor transplants were har-vested from great toe in 14cases,fro m 2nd toe in 35cases.All finger recon struction cases were taken from2nd toe.Results Postoperative arterial crisis occu rred in 10digits and venous crisis in4.All digits survived after operative and medication trea tment.Twenty digits underwent seco ndary plastic operation for better c os-metic effect.Forty-two digits in 38cases followed-up from 6months to 13years revealed good pulp pinch function.Sensation recovery to S3 + and above in 30cases(34digits)and two-point discrimination from 6-8mm in 30digits.The patients were satisfied with the appearance of the reconstructed thumb and fingers.There were no major complication in the don or toes.Conclusion The defect of distal segment and finger tip of thumb and /or finger can be reconstru cted by transplantation of partial t issues from the great,2nd or /and 3rd toe.The operation will not be influenced by anomaly of the blood vessels.Both ultimate function and cosmetic effect can meet the patientsdesire.[