不牺牲足趾的第二趾皮瓣瓦合再造手指中末节缺损

Second toe preserving wrap-around flap for reconstruction of defect in the middle and distal segments of the finger

目的探讨不牺牲足趾的第二趾皮瓣瓦合再造手指中末节缺损的方法和临床疗效。方法自2010年6月至2015年5月，对27例27指不同程度中末节手指缺损的患者，在不牺牲足趾的前提下，采用取髂骨植骨、足第二趾甲背皮瓣与对侧第二趾胫侧皮瓣瓦合再造手指。第二趾供区均采用髂腰部全厚皮片植皮修复。结果术后再造指体全部存活，随访4～24个月，平均9个月，再造指指腹饱满，指甲生长良好，指体外形良好，指腹感觉恢复满意，指腹皮肤感觉S～S＋，全部病例指背均恢复保护性感觉，手指关节功能接近正常，足部供区愈合好，无瘢痕增生，行走完全正常。结论取髂骨植骨、足第二趾甲背皮瓣与对侧第二趾胫侧皮瓣瓦合再造手指，是一种不牺牲足趾的较好的手指再造方法。

Objective To report the surgical techniques and clinical outcomes of middle and distal finger reconstruction using second toe preserving wrap-around flap. Methods From June 2010 to May 2015, various degrees of defects of the middle and distal phalanx of 27 fingers in 27 patients were reconstructed with a second toe preserving procedure. An iliac bone graft, wrap-around flap from the ipsilateral second toe and tibial flap from the contralateral second toe were combined and transferred to reconstruct the missing finger. The donor sites of the second toes were covered with full-thickness skin graft from the iliohmlbar area. Results All the reconstructed fingers survived. Postoperative follow-up period ranged from 4 to 24 months with an average of 9 months. The appearance of the reconstructed finger was satisfactory with plump pulp and proper nail growth. Sensory recovery of the finger pulp was raled S2 to S3 ＋ , while protective sensation was reslored to the dorsum of the fingers in all the cases. Joint movement of the fingers was near normal. Donor sites at the feet healed well. Walking was not impaired. Conclusion Combined transfer of iliac bone graft, wrap-around flap from the ipsilateral second toe and tibial flap from the contralateral second toe is a good option for finger reconstruction without sacrificing the second toe.