第二足趾移植再造手（拇）指并一期外形重塑的临床分析

Clinical analysis of reconstruction of thumb or finger by free second-toe transfer and one stage appearance remodeling

目的 总结游离第二足趾行手（拇）指移植再造并一期采用5种方法重塑第二足趾外形的临床疗效. 方法 2007年10月至2013年8月,我院对109例128指Ⅴ度以内拇、手指缺损的患者行游离第二足趾进行移植再造,同时一期行第二足趾外形重塑.其中一期行甲床延长扩大20指;一期行甲床延长扩大同时加趾腹两侧正“八”字切除23指;一期甲体延长扩大加（足母）趾腓侧岛状皮瓣嵌入第二足趾中节跖侧狭窄部分29指;一期甲体延长扩大加趾腹腓侧棱形皮瓣旋转嵌入中节狭窄部分19指;一期采用甲体延长扩大加趾腹正中梭形切除加（足母）趾腓侧岛状皮瓣嵌入中节狭窄部分的37指.术后对79例患者进行了3个月～5年不等的适时随访,受访率73％,随访记录不完整及失访30例,失访率27％,失访原因中大部分为外来务工人员,痊愈后返回原籍. 结果本组109例128指再造拇、手指全部成活.再造拇、手指外形恢复满意,指甲外形较未行甲体延长扩大者明显改善,中节狭窄部分外形明显改善,恢复满意.本组随访79例,其再造拇、手指的功能及感觉恢复较为理想,供足行走正常,无跛行、疼痛等后遗症.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进行评定：优43例,良26例,可10例,优良率87％. 结论采用第二足趾一期外形重塑后移植再造手（拇）指的方法,明显改善了足趾外形,可一次完成手术,术前需认真设计,有时需采用上述几种术式相结合,制定个性化手术方案,达到预期目的.

Objective To explore the effects of reconstruction and shaping of thumb or finger defects by free second-toe transfer and one stage appearance remodeling.Methods From October,2007 to August,2013,128 thumb or finger Ⅴ degree defect of 109 cases were reconstruct with free second-toe transfer,and one stage shape remodeling at the same time.Among them,20 fingers by nail bed expand one stage; 23 fingers were nail bed expand added on toe pulp splayed resection on both sides; 29 fingers were added on embedded the philp island flap of great toe to the section of plantar side narrow part in the second digit,19 fingers were added on embedded the abdominal phil chamfered-edge-shape flap to that narrow part in the second digit,and 37 fingers added on toe pulp resection and embedded the philp island flap of great toe to that narrow part.Results All reconstructed thumb or fingers survived and appearance were good.The nail shape of reconstructed thumb or fingers were improved obviously,the shape of narrow part in middle segment was recovered satisfactorily.Seventy-nine cases （72.5%） were followed-up from 3 months to 5 years,and the other 30 cases （27.5%） were lost.The function of the reconstructed thumb or finger and hand feeling was ideal recovered.There were no claudication,no pain and no other sequelaes for donor foot.According to the Standard on Approval of Reconstructed Thumb and Finger Functional Assessment of Chinese Medical Association,43 cases excellent,26 cases good,10 cases approve.The rate of excellent and good was 87%.Conclusion Second-toe transfer and shape remodeling is a good method of thumb or finger reconstructing.The appearance of the thumb reconstruction can be improved obviously.Preoperative carefully design and the combination of the above several kinds of operation,for draw up an personalized surgical program is necessary.