游离带第一跖背动脉皮支皮瓣和第二趾移植再造拇手指并修复邻指创面

Free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent fmger wound

目的探讨带第一跖背动脉皮支皮瓣和第二趾移植再造拇手指缺损，并利用第一跖背动脉皮支皮瓣修复缺损手指邻近手部创面的方法和临床疗效。方法自2010年6月至2015年6月对9例拇手指缺损伴邻近手指创面皮肤软组织缺损的患者，采用带第一跖背动脉皮支皮瓣和第二趾移植再造拇手指缺损，并利用第一跖背动脉皮支皮瓣修复缺损手指邻近手部创面。切取所带的第一跖背动脉皮支皮瓣面积为3．3cm×2．0cm～5．2cm×3．0cm。供区创面均游离植皮修复。结果术后1例皮瓣远端出现张力性水泡，经拆线、换药后愈合。余再造手指、皮瓣及植皮均I期愈合。9例患者随访时间6～32个月，平均15个月。皮瓣外观、弹性好，质地柔软。再造指外形、功能可。患足负重行走无明显影响，供区植皮创面无溃疡。结论带第一跖背动脉皮支皮瓣和第二趾移植再造拇手指缺损，并利用第一跖背动脉皮支皮瓣修复缺损手指邻近手部创面血供可靠，操作安全，符合修复原则，是一种理想的修复方法。

Objective To explore the surgical method and clinical effects of free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound. Methods From June 2010 to June 2015, 9 cases of thumb defect and adjacent finger soft tissue defects were treated using free second toe transplantation with the first dorsal metatarsal artery flap. The area of the first dorsal metatarsal artery flap ranged from 3.3 cmx2.0 cm to 5.2 cmx3.0 cm. Free skin grafts were used to repair donor site. Results Postoperatively tension blister at the distal end of the flap occurred in 1 case which were healed after removal of stitches and change of dressing. Other reconstructed fingers, flaps and skin grafts achieved primary healing. All the patients were follow-up for 6 to 32 months with an average of 15 months. All the flaps presented good appearance and elasticity with soft texture. The appearance and function of the reconstructed thumbs were good. There was no obvious effect on foot load walking. No skin ulcer occurred in donor site. Conclusion Free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound is an ideal method for repairing due to the reliable blood supply, safe operation and accordance to repair principle.