带趾骨的（足母）甲瓣与第2趾近侧趾间关节移植修复拇指Ⅱ～Ⅲ度缺损

Reconstruction of thumb Ⅱ-Ⅲ degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint

目的 探讨采用带部分（足母）趾末节趾骨的（足母）甲瓣＋第2趾近侧趾间关节组合移植修复拇指Ⅱ～Ⅲ度缺损的方法.方法 2004年5月至2012年7月,对25例25只拇指外伤性Ⅱ～Ⅲ度缺损,根据健侧指近、末节指骨的总长度、末节指骨长度、末节指体最粗处周径、甲床长度及宽度,以及修整后的伤指近节指骨残留长度、近节残指体长度等测量数据,设计同侧足带部分（足母）趾末节趾骨的（足母）甲瓣＋第2趾近侧趾间关节移植修复拇指缺损;供区（足母）趾趾端用组织切取后残存的胫侧皮瓣覆盖,（足母）腓侧创面移植皮片或用皮瓣修复;第2趾骨缺损区采用（足母）趾末节多余骨质＋拇指残端修整后残存骨质,或截取适量髂骨填充,维持第2足趾原长,或者将关节切取后两端骨断面直接对合固定.结果 本组25例25只再造指全部成活,术后随访6 ～ 26个月,无移植关节退行性变,所有移植组织均成活,供足也均无功能影响,患者满意度高.根据中华医学会手外科学会上肢部分功能评定试用标准,优10例,良11例,总优良率84％,效果较差4例,其中2例移植骨关节坏死,2例移植关节远端骨折面迁延不愈,均作去除死骨,取髂骨植骨处理.结论 无论是术后再造指的外形及功能,还是对供足的外形及功能的影响,本手术方法均是拇指Ⅱ～Ⅲ度缺损较好的修复方法.

Objective To investigate the reconstruction of thumb Ⅱ-Ⅲ degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint.Methods Between May 2004 to July 2012,25 cases with thumbs Ⅱ-Ⅲ degree defects were treated.The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side.The distal end of hallux was covered by flap at tibial side.The wound at the fibula side was covered by skin graft and flap.The bone defect at the second toe was filled with remnant hallux or iliac bone.Results All the 25 reconstructed thumbs survived completely.The patients were followed up for 6-26 months without any joint degeneration.According to the finger reconstruction functional criterion publicized by China Medical Association,the finger function was assessed as excellent in 10 case,good in 11 cases,poor in 4 cases.Joint necrosis happened in 2 cases and bone malunion in 2 cases.The 4 cases received dead bone debridement and iiiac bone graft.No malfunction occurred in the donor site.Conclusions Our surgical method is a currently effective way to reconstruct Ⅱ-Ⅲ degree thumb defects.Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.