足趾组织移植拇、手指再造208例分析

Reconstruction of Thumb and Finger by Transplantation of Composite Toe Tissues: Experience in 208 Cases

自1979年10月以来,应用吻合血管的足趾组织移植再造拇手指208例242指,成功204例238指,失败4指,成功率为98.34%。单纯拇指缺损135例,单纯手指缺损28例,拇手指同时缺损45例。再造拇指166例168指,再造手指28例42指,拇手指同时再造14例32指。选第二足趾移植再造188例,拇甲瓣移植再造18例。术中遇第一蹠背动脉属GilbertⅢ型30例34足全部获再造成功。本文对拇指缺损的分度与再造适应症,再造方式与指数,血管解剖变异的处理,血管吻接方式,急症再造,带足背皮瓣的足趾组织移植等进行了讨论。

Transplantation of composite toe tissues with microsurgical technic has boen performed in 208 patients since Oct. 1979. Among the 242 digits reconstructed, 238 digits (204 patients) were successfully reconstructed and other four digits (4 patitents) failed. The success rate was 98.3%. In this series, 135 cases were loss of thumb, 28 cases loss of fingers, and 45 cases loss of both thumb and fingers. The reconstruction procedures were composed of thumb reconstruction in 166 cases (168 thumbs), finger reconstruction in 28 cases (42 fingers) and both thumb and finger reconstruction in 14 cases (32 digits). The transplantation of second toe were performed in 188 cases and nail-skin flap of great toe transplantation were used in 18 cases. Gilbert Ⅲ variation of the first dorsal metatarsal artery was encountered in 34 donor feet in 30 patients. All these cases were successfully operated upon. A new classification system of thumb loss is proposed. The indication of various operative procedures, different ways of vascular anastomosis, the choice of emergency reconstruction, the use of graft of toe extended with dorsalis pedis flap and the pitfalls of the operation were discussed in detail.