（踇）趾断层甲床游离移植修复手指甲床缺损

Free grafting of big toe nail bed repairing defects of fingernail bed

目的 探讨（踇）趾断层甲床移植修复手指甲床缺损的可行性及适应证.方法 2008年9月至2011年9月,采用躅趾断层甲床游离移植修复13例手指甲床缺损.男9例,女4例,年龄17-38岁,平均32岁.手术均取（踇）趾甲床,切取范围以实际缺损测量值为准,深度一般以甲床供区不露骨为准,最好切取断层甲床的1/2以下.结果 术后3例全部坏死,二期以皮瓣修复;2例部分坏死,经换药后愈合.其余患者移植甲床成活良好,创面一期愈合.足趾供区均一期愈合.患者均获6～30个月随访,平均14个月.疗效评定：优8例,良2例,差3例,优良率达76.9％;甲基质完整者优8例,良l例,差l例,优良率达90％.供区足趾甲生长良好.结论 甲基完整的单个手指甲床缺损,采用（踇）趾断层甲床移植修复,能恢复指甲外观和功能,对足部供区无明显影响,但对甲基质缺损者慎用.

Objective To investigate the feasibility and indication of free grafting of split big toe nail bed for defects of fingernail bed.Methods From September 2008 to September 2011,13 cases （4 females and 9 males） with fingernail bed defects（aged 17-38,average,32） were treated with split big toe nail bed.The split big toe nail was harvested according to the defects size without bone exposure at donor site.Results Three grafted nail beds were necrotic completely and reconstructed with flaps.The 2 grafted nail bed was partial loss and healed after dressing.All the other grafted nail bed survived completely with primarily healing both in donor sites and recipient sites.The patients were followed up for 6-30 months（average,14 months）.The therapeutic effect was graded as excellent in 8 cases,good in 2 cases and poor in 14 cases（good rate,76.9%）.The nail matrix was excellent in 8 cases,good in 1 case and poor in 1 case（good rate,90%）.The toe nails in donor sites grew well.Conclusions The single fingernail defect with intact nail matrix can be reconstructed by split toe nail bed graft with good cosmetic and functional effect.There is no malfunction at donor site.The indication should be selected.