第2趾甲皮瓣联合手指岛状皮瓣修复手指中末节皮肤脱套伤

Island flap of finger combined with transplantation of nail skin flap from the second toe for repair of degloving injury of fingers

目的介绍一种修复手指中末节皮肤脱套伤的新方法。方法对9例9指中末节皮肤脱套伤（AdaniⅣ级）采用带趾甲的第2趾背皮瓣联合带双侧指固有神经背侧支的手指岛状皮瓣进行修复，趾背皮瓣游离平面位于趾伸肌腱表面。趾背皮瓣的血供重建方式为第1跖背动脉一指固有（指总）动脉、第1跖背静脉一指背静脉或足背动脉一鼻烟窝桡动脉、大隐静脉一头静脉。手部感觉重建方式为手指岛状皮瓣双侧指固有神经背侧支一伤指双侧指固有神经。结果本组9指全部成活．术后随访6~12个月，伤指外形及屈伸功能均满意，两点辨别觉为6~8mm。结论用第2趾甲皮瓣联合带指神经背侧支岛状皮瓣修复手指中末节皮肤脱套伤，伤指有指甲和丰满的指腹，可最大限度地恢复伤指的外形和功能。

Objective To introduce a new operating procedure for repair of degloving injuries of the fingers. Methods Nine degloved fingers in nine cases were repaired by island flap of finger with dorsal branches of digital proper nerve and transplantation of nail skin flap from the second toe with no or partial distal phalanx. The dissection level of nail skin flap was on the surface of the flexor and extensor tendons. The blood supply of the nail skin flap was restored by anastomos- ing first dorsal metatarsal artery with digital proper （common） arteries, first dorsal metatarsal saphe- nous vein with cephalic vein. The sensory reconstruction of finger was performed by anastomosing bilateral dorsal branches of digital proper nerve of island flap with bilateral digital proper nerve of injuried finger. The blood supply of the island flap is the digital proper artery of non-injury finger. Results All the flaps survived. Satisfactory appearance and good function were obtained in eleven fingers with normal sensation and 2-PD of 6~8 mm after 6~12 months fllow-up. Conclusion Island flap of finger combined with transplantation of nail skin flap from the second toe could repair the defects of skin, nail and finger pulp of the degloved fingers. The function and the appearance of the injured fingers were satisfactory.