微型甲瓣移植修复拇手指末节复合组织缺损

Repairation of composite distal soft tissue defect of thumb and finger with mini toenail flap

目的探讨微型甲瓣游离移植修复拇、手指末节皮肤及甲周组织缺损的手术方法、治疗效果及临床意义。方法2015年6月至2018年6月,应用微型甲瓣移植修复7例7指(拇、示、中指)末节复合组织缺损,所有患者均有末节皮肤和甲周组织的同时缺损,并伴有肌腱或骨骼外露。术中切取趾复合组织瓣面积为4.5 cm×3.0 cm^3.0 cm×1.5 cm,皮瓣供区经趾骨短缩后直接缝合、趾腹V-Y推移皮瓣或利用局部皮瓣覆盖。术后显微外科常规治疗,并随访患者伤指的感觉及运动恢复情况。结果术后7例7指皮瓣完全成活。随访时间6~36个月,伤指修复后外观满意,修复后指腹的两点辨别觉恢复至4~6 mm,足趾供区无功能障碍。结论微型甲瓣修复拇、手指末节复合组织缺损,能最大程度的恢复拇、手指特有的解剖结构,一期恢复指腹的自然外观和感觉,是一种良好和可靠的修复方式。

Objective To introduce the repairation procedure of composite distal soft tissue defect of thumb and finger with mini toenail flap. Methods From June, 2015 to June, 2018, 7 cases with composite tissue defect at 7 distal fingers, including 5 thumbs, 1 index finger and 1 middle finger, were reconstructed with mini toenail flap transfer. The flap sizes which were raised during the operation ranged from 4.5 cm×3.0 cm-3.0 cm×1.5 cm. The donor sites were covered by toe phalanx shortening, V-Y advancement flap and local pedicle flap. Microsurgical routine treatment was made after the operation, and followed-up regularly. Results Seven flaps of 7 cases completely survived without any necrosis. All the wounds at the donor sites healed well. All patients were followed-up for 6-36 months. The motive, sensor and cosmetic result were satisfied. In sensory function, the two-point discrimination distance could restore to be 4-6 mm. Conclusion The mini toenail flap transfer is a reliable and suggested method. It can anatomically restored the distal digit sensor function with cosmetic contour, and regain the motive, sensory function and satisfied cosmetic appearance.