共用一套足背动脉供血系统的第二足趾和足背寄养指联合移植再造手

Hand reconstruction by transplanting the fostered residual finger and second toe which share the same blood supply system

目的探讨在手毁损伤中利用共用一套足背动脉供血系统的第二足趾和寄养指移植再造手的新方法与效果。方法自2014年1月至2016年1月，收治手部毁损性离断患者3例．一期将残留指寄养于足背．手部清创后植皮覆盖。二期解剖游离出共用一套足背动脉供血系统的第二足趾和寄养指．共同移植再造手。结果3例再造手均成活良好。定期进行电话及回院随访3个月～2年。再造手外观良好，最大程度上恢复了患肢的功能，患者对再造手感到满意。结论利用共用一套足背动脉供血系统的足部寄养指和第二足趾共同移植再造手是一种可行的手术方法，具有操作简单、外形美观及功能良好等优点，最大程度上恢复了患肢的功能．降低了致残率。

Objective To investigate the methods and results of hand reconstruction by transplanting the fostered residual finger and the second toe, which share the same blood supply system. Methods From January, 2014 to January, 2016, 3 cases with destructive hand injuries in our hospital; and debridement was performed in one session during the early stage of trauma, with skin grafting to cover the wrist stump and foster the residual finger to a branch of the dorsalis pedis artery. The first dorsal metatarsal artery around the toe web was identified and then grad- ually isolated proximally with dissection of the branches of the dorsalis pedis artery supplying the fostered finger until the convergence of the two blood vessels. Then , reconstructed hand by residual finger and combined second toe transplantation. Results After a follow-up period of 3 months to 2 years, the reconstructed hand had a good appearance and was able to complete basic mundane actions. The function of the limb was restored to a large extent and the patient was satisfied with the reconstructed hand. Conclusion Transfer of a fostered residual finger and combined second toe which have the same blood supply system for hand reconstruction as a new method need to anastomose only one set of arteries, and it is feasible with the good appearance and function of the reconstructed hand.