游离旋髂浅动脉穿支嵌合骨皮瓣修复拇指再造术后的足部供区

Repairing donor site of foot after improved toe-to-thumb reconstruction utilizing superficial circumflex iliac artery perforator chimeric flap

目的探讨游离旋髂浅动脉穿支嵌合骨皮瓣修复拇指再造的足部供区的疗效。方法从2012年4月至2016年1月，应用旋髂浅动脉穿支嵌合骨皮瓣修复14例拇指缺损再造术后足部供区。根据顾玉东分型法．其中5例为Ⅰ度缺损．采用游离躅甲瓣再造拇指，4例为Ⅱ度缺损，5例为Ⅲ度缺损，均应用游离同一血管蒂的躅趾甲皮瓣包裹第二足趾骨腱组织全形再造拇指。蹈趾供区皮肤缺损及足趾骨缺损均采用游离旋髂浅动脉穿支骨皮复合组织瓣修复．腹部供区均直接缝合。结果术后14例再造拇指全部成活，1例皮瓣出现静脉危象，经过手术探查后成活．1例第二足趾出现趾背部分皮肤发黑坏死。术后给予局部皮瓣转移后创面完全愈合。术后随访3～30个月（平均16个月）。供区躅趾皮瓣色泽、质地较满意，但略显臃肿，足部骨折平均愈合时间为2．5个月．足部无疼痛等不适．不影响行走及跑步，有5例患者术后3个月对足部皮瓣进行修整，外观更加良好。腹部供区均只存留一线性瘢痕．无明显不适。结论应用游离旋髂浅动脉穿支嵌合骨皮瓣修复拇指再造术后的足部供区．能同时修复足部供区骨皮复合组织缺损，在再造拇、手指获得良好外观和功能的同时能恢复足部供区的解剖结构．保留其长度及其功能．是足部供区修复的一种理想术式。

Objective To evaluate the clinical outcome of the method of repairing donor site of foot after im- proved toe-to-thumb reconstruction utilizing superficial circumflex iliac artery perforator （SCIAP） chimeric flap. Methods Fourteen cases of thumb defect were recruited from April, 2012 to January, 2016. According to Gu Yudong＇s classification, 5 cases met the criterion of type I, 4 cases met the criterion of type II, and 5 cases met the criterion of type III. For type I, the thumb was reconstructed with the great toe wrap-around flap. For type II and III, the thumb was reconstructed by the combined tissue with mutual artery （great toe wrap-around flap, and the bone- tendon tissue of the second toe）. All the donor sites of foot were repaired utilizing SCIAP chimeric flap. Results All the reconstructed thumbs survived. Among 14 free flaps of donor site, 1 case suffered venous crisis and survived after exploration and rescue surgery. Dorsal skin necrosis of the second toe was found in 1 case, which was healed by local skin flap transposition. All patients were followed-up ranged from 3 to 30 months （averaged at 16 months）. In spite of slightly bloated, the color and texture of all the flaps＇ was satisfied, and the average healing time of the bone in the donor sites was 2.5 months. All patients did not feel painful and had no adverse effect when walking and running. Three months after the operation, 5 slightly bloated flaps in the donor sites under went flap plastic and achieved better ap- pearance. On the part of iliaca, there was only one inconspicuous linear scar without any discomfort. Conclusion Re- pairing donor site of foot after improved toe-to-thumb reconstruction utilizing SCIAP chimeric flap was an ideal method. Using this method, the reconstructed thumb can achieve good appearance and function, all the toes of donor site were reserved, and the disability of the donor site is minimized.