甲皮瓣联合趾侧方皮瓣修复指端复合组织缺损

Repair of complex tissue defects of fingertip with second toe wrap-around flap combined with toe medial flap

目的探讨游离足第2趾甲皮瓣联合趾侧方皮瓣修复指端复合组织缺损的治疗方法及疗效。方法自2008年2月至2012年4月，对9例10指甲床部分缺损同时伴有指端皮肤软组织缺损的患者采用游离足第2趾甲皮瓣联合趾侧方皮瓣进行修复，并对疗效进行分析。结果移植后的甲床及皮瓣全部成活，伤口愈合良好。术后随访4～24个月，平均14个月，全部移植指甲生长良好，指端外形接近正常，触觉恢复满意，手指远侧指间关节活动度正常，可以抓捏细小物体；足部供区愈合良好，足功能无明显影响。参照Zook指甲修复标准评定：优8指，良2指，优良率达100％。结论应用游离足第2趾甲皮瓣联合趾侧方皮瓣修复指端复合组织缺损，可以最大限度地恢复手指的外形及功能，对供区损伤小，是修复手指指端复合组织缺损的理想方法。

Objective To explore the method and treatment effect of second toe wrap-around flap com- bined with toe medial flap on repairing complex tissue defects of fingertip. Methods From February 2008 to A- pril 2012, 9 patients （10 fingers） with fingertip tissue defects accompanied by nail bed defects were treated by second toe wrap-around flap and toe medial flap, and the effects were analyzed. Results All transplanted nail beds and flaps survived with good healed incisions. Patients were followed from 4 months to 24 months with an av- erage of 14 months. All the nails growth well and the appearance and tactile sense of fingertip were satisfactory. Range of active motion in the distal interphalangeal joint was normal. The repaired fingers could pinch small ob- jects. The donor sites of the flaps healed well and all patients walked without interference. The repaired nails as- sessed by Zook Standard were excellent in 8 fingers, and good in 2 fingers, and the excellent and good rate was 100%. Conclusion It is an ideal method to repair fingertip tissue defects using second toe wrap-around flap combined with toe medial flap. The method can restore the appearance and function of the injured finger and re- sult in less damage to the donor site.