岛状组织瓣重建发育不良多拇畸形及美学评价

Neurovascular island flap for pulp and nail aul^entation in thumb duplication reconstruction

目的介绍一种采用带部分指甲及指腹的神经血管岛状组织瓣转移对发育不良的多拇畸形进行指体重建的方法，并对重建拇指的美学效果进行评估。方法自2002年12月至2010年11月，我们采用改良Bilhaut—Cloquet术治疗8例单侧多拇畸形患儿，其中WasselⅡ型1例、Ⅲ型1例、Ⅳ型6例，患侧两个拇指均存在明显的指腹和指甲发育低下。术中从拟切除的拇指切取指甲指腹岛状组织瓣转移至拟保留的拇指。术后随访对所有重建拇指按新的美学评分系统进行评价。结果术后所有组织瓣均存活。术后随访时间为25～120个月，平均80个月，重建拇指背侧无明显手术瘢痕，指腹和甲襞的不对称得以改善，指甲宽度和指腹周径与健侧接近。美学评分系统可以较好地评价术后手指外观优劣，评价结果与患者家长的满意度一致。结论对于多拇畸形拟保留拇指明显发育不良的患者，带部分指甲及指腹的神经血管岛状组织瓣转移修复是一种安全有效的改善重建拇指外观的方法。

Objective To introduce a neurovascular island flap for pulp and nail augmentation, and combined with a dorsally based skin flap approach, to improve the esthetic result in thumb duplication reconstruction. Methods Eight cases of thumb duplication, including 1 Wassel type Ⅱ , 1 type Ⅲ and 6 type Ⅳ , were treated with modified Bilhaut-Cloquet procedure between December 2002 and November 2010. All the patients had significant hypoplasia and asymmetry of the pulp and nail of the duplicated thumbs. Nail and pulp flaps were dissected from the thumb to be excised and transferred to tile thumb to be retained. All the patients were follow-up to monitor the esthetic, functional and radiological outcomes, The average follow-up was 80 months （range, 25 to 120 months）. An esthetic scoring system was proposed to assess the cosmetic results of thumb duplication reconstruction. Results All the flaps survived. There was no visible surgical scar on the dorsal aspect of the thumb. Pulp and nail fold symmetry was improved in all cases. Nail width and pulp circumference were close to those on the nonnal side. The proposed esthetic scoring system was able to assess and highlight the cosmetic aspect of the outcome, which was well correlated to the parents＇ satisfaction. Conclusion In selected case of thumb duplication with significant hypoplasia and pulp and nail asymmetry, the neurovascular pulp and nail island flap is a safe and effective approach to restore symmetry, for esthetic improvement.