吻合血管的趾断层甲床皮瓣移植修复手指甲床及软组织缺损

Transplantation of slice nail bed flap of great toe with vascular anastomosisin repairing nail bed and soft tissue defect of fingers

目的探讨吻合血管的趾断层甲床皮瓣移植修复手指甲床合并软组织缺损的临床疗效。方法 2015年1月-2018年3月,应用吻合血管的趾断层甲床皮瓣移植修复外伤导致的手指甲床及软组织缺损16例(16指)。本组男11例,女5例;年龄16~39岁,平均23岁;损伤指别:拇指3例,示指8例,中指5例;甲床缺损范围为0.8 cm×0.5 cm^1.2 cm×l.0 cm,软组织缺损范围1.2 cm×1.0 cm^2.5 cmxl.5 cm;受伤至手术时间1~8 h,平均3.6 h;术中趾断层甲床皮瓣切取范围为2.5 cm×1.2 cm^3.2 cm×1.8 cm,供区直接缝合所有患者术后定期进行随访,观察指甲外观、功能及供区愈合情况,其中门诊随访11例,微信随访4例,电话随访1例:结果术后断层甲床皮瓣均顺利成活,创面I期愈合;供区切口均I期愈合。患者均获随访,随访时间6~18个月,平均9个月。1例指甲出现纵棘,外观粗糙,其余患者指甲外观良好;皮瓣外形、质地、弹性良好。术后6个月,皮瓣两点辨别觉为6~12 mm,平均8 mm;供区趾外观有一定影响,但趾甲生长良好,无行走痛;根据指甲再生疗效评定标准评定,优12例,良3例,可1例结论应用吻合血管的趾断层甲床皮瓣移植修复手指部分甲床合并软组织缺损是治疗手指甲床缺损的有效方法之一。

Objective To discuss the clinical effect of transplantation of slice nail bed flap of great toe with vascular anastomosis in repair of partial nail-bed and soft tissue defect at fingers. Methods From January. 2015 to March, 2018, 16 cases (16 fingers) of partial nail-bed defect at fingers were repaired with transplantation of slice nail bed flap of great toe with vascular anastomosis. All cases were combined with palmar soft tissue defect at distal segment fingers. The area of nail bed defects were from 0.8 cm×0.5 cm to 1.2 cm×1.0 cm. The area of soft tissue defects were from 1.2 cm×1.O cm to 2.5 cm×1.5 cm. The average time from injury to operation was 3.6 hours after injuries (ranging from 1 hour to 8 hours). The area of slice nail bed flap incised during operation were from 2.5 cm×1.2 cm to 3.2 cm×1.8 cm, and the donor site was sutured directly. All patients were followed-up regularly for nail appearance, function and donor healing. Among them, 11 cases were followed-up by clinic, 4 cases by WeChat, and telephone follow-up was performed in 1 case. Results The nail-bed flap after transplantatio n survived successfully. The followed-up time were from 6 to 18 months, the average time was 9 months. Longitudinal spine and rough appearance occurred in 1 case. Others were flat, smooth, complete attachment of nail body and nail bed. The flaps had good appearance, texture and elasticity at 6 months after surgery, and two-point discrimination was 6-12 mm(average, 8 mm). The toenails at donor sites grew well. No walk-associated pain after long-term following-up. Six months after surgery, according to standard for efficacy evaluation of nail regeneration. 12 cases were excellent, 3 cases were good and 1 case was acceptable. Conclusion Transplantation of slice nail bed flap of great toe with vascular anastomosis in repair of partial nail-bed and soft tissue defect at fingers is one of the effective methods for repairing nail-bed defect at fingers.