[足母]甲皮瓣与带跖骨的第二趾复合组织组合再造拇指

The big toe wrap-around flap combination of the second phalange with the metatarsal to reconstruct the thumb

目的探讨[足母]甲皮瓣与带跖骨的第二趾复合组织组合再造拇指的手术方法和临床效果方法2014年6月至2016年12月，共收治6例拇指V度缺损的患者，采用[足母]甲皮瓣与带跖骨的第二趾骨、关节、肌腱等复合组织组合再造拇指．跖趾关节附近截断跖骨头．跖骨头沿矢状面由背侧向跖侧翻转70°～80°，修整骨折断面后与跖骨重组．重建掌指关节及部分掌骨。6例均获得随访。结果再造拇指6例全部成活，术后随访6．24个月。再造拇指外形与健侧相近．指端两点分辨觉1．0～2．0cm。对掌功能恢复满意，掌指关节活动度屈曲最大可达50°同时有适度背伸功能。指骨愈合良好、无明显骨质吸收及关节变性。供足外形及功能均恢复良好。按照中华医学会手外科学会上肢部分功能评定试用标准评定：优3例，良3例。结论应用躅甲皮瓣与带跖骨的第二趾复合组织再造的拇指．重建了掌指关节及部分掌骨．使再造后的拇指恢复了掌指关节的生理弧度及合适的长度，功能满意，是修复拇指伴掌骨缺损的良好方法。

Objective To explore the surgical technique and treatment outcomes of the big toe wrap-around flap combination of the second phalange with the metatarsal to reconstruct the thumb. Methods From June, 2014 to December, 2016, 6 patients of the thumb defects on V degree, we took the big toe wrap-around flap with the second toe and the metatarsal to reconstruct the thumb. The metatarsal head was truncated nearby the metatarsophalangeal joint,and the metatarsal head was turned 70^-80~ from the dorsal side to the plantar side, then recombinated the metatarsal after dealed with the fracture, so it can rebuild the metacarpophalangeal joints and the metacarpal. 6 cases were followed up. Results All cases survived, and they were followed up duing 4 to 24 months after operation. The shape was similar with uninjured sides and the two-point discrimination was 1.0-2.0 cm. The function recovered satis- factorily and the maximum flexion of the metaearpophalangeal joints can reach 50 degrees, at the same time, it has the function of dorsiflexion. They were got bone healing and there was no bone absorption and joint degeneration. The donor foot has no ulceration, and walking without the pain and lameness. According to the Upper Extremity Functional functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, there were excellent in 3 cases and good in 3 cases. Conclusion Combined the big toe wrap-around flap with the second toe and the metatarsal to reconstruct the thumb, it can rebuild the metacarpophalangeal joints and metacarpal, we can get the thumb which have the physiological curvature and the suitable length, the configuration and the function were satisfac- tory. It is an effective method for reconstruction of the thumb defect onVdegree.