部分（足母）趾末节甲瓣移植再造拇指甲床缺损

Partial toenails flap to reconstruct thumb nail bed defect

目的 探讨应用部分趾末节甲瓣修饰性再造拇指甲床缺损的临床效果. 方法 根据拇指创面、缺损大小情况设计甲瓣,遵循＂缺多少,切取多少＂的原则切取足趾腓侧甲床,原则上至多切取趾末节2/3的腓侧趾体,保留1/3胫侧趾体. 趾残留甲床、骨骼及皮肤软组织体于甲根部咬断骨骼,组织体旋转90°转移覆盖趾创面. 吻合趾—指固有动脉、 神经和趾—指背侧静脉. 结果 自2009年8月—2014年8月应用趾甲瓣修饰性修复拇指甲床缺损13例,术后13例部分趾末节甲瓣均成活.术后经过8-36个月随访,再造拇指外形良好,持物时无疼痛、感觉过敏,持物方便舒适,两点辨别觉5-10 mm. 按中华医学会手外科分会再植与再造功能评定试用标准评定,优良率95%;足部供区行走无影响,趾保留部分趾甲生长,外观良好. 结论 部分趾末节甲瓣修饰性再造拇指甲床缺损临床治疗效果良好.

Objective To explore clinical effect of modified hallux toe distal part of the flap to reconstruc thumb nail bed defects. Methods According to the situation of wound and defect of thumb, made a design for the hallux toe, follow the principle of ＂Take the amount how much do you wan.＂In principle, cut hallux toe at most for 2/3 of fibial side and keep the 1/3 in tibia lateral. Bite the residual nail bed and bone of the hallux toe in the root of nail bed,and then rotate 90 ° and cover the wound in the big toe. Match the toe-refers to the inherent artery, nerve and toe-refers to the dorsal vein. Results From August 2009 to August 2014, we were successful in all 13 cases of modification reconstruction for the thumb nail bed defect with part of hallux toe witch has a disc nail bed.After 8 - 36 months postoperative follow-up, we saw the thumbs that were reconstructed have good appearance and feeling, no pain and hyperesthesia, convenient and comfortable when holding. The two-point discrimination was 5 to 10 mm. According to the functional evaluation standard for replantation and reconstruction of the Medical Association of hand surgery branch, the excellent and good rate was 95%. The donor site of foot to walk has effect.The hallux toe retaining part toenail were in good growth, and had a good appearance. Conclusion Part of hallux toe nail flap reconstruction of distal modified distal thumb nail defect can obtain good clinical effect.