游离第2足趾组合跚甲瓣移植再造缺损拇指九例

Reconstruction of thumb defect by transplanting second toe combined with hallucis flap:9 cases report

目的介绍--种游离第2足趾与部分跨甲瓣组合移植,改良再造缺损拇指的手术方法。方法2012年6月-2017年2月,共收治拇指缺损9例,平均年龄26岁,拇指缺损平面为I1类A区-1II类A区。根据拇指缺损情况,于对侧足第1.2足趾设计切口,切取共干的第2足趾和蹄甲瓣。以第2足趾为主瓦合跚甲瓣,将切取的路甲瓣趾甲旋转90°,与第2足趾趾甲远端衔接,路趾皮瓣覆盖于第2足趾鹅颈狭窄部,从而增加再造指的周径及趾甲长度。术后定期随访。结果本组9例皮瓣均成活,供受区创口-.期闭合。术后随访4~12个月,平均7个月,再造指均成活良好,外形美观,功能正常。按中华医学会手外科学会上肢部分功能评定试用标准进行手功能评定:优6例,良3例。所有患者生活自理,供区足趾损伤小,外形、功能良好。结论游离第2足趾组合跚甲瓣移植再造拇指缺损的手术方式能够有效的改善第2足趾趾甲扁小、末节膨大,鹅颈畸形等足趾特征再造指外形逼真、美观,功能良好。

Objective To introduce the method for reconstruction of thumb defect by transplanting free flap of second toe combined with the hallucis flap.Methods From June,2012 to February,2017,a total of 9 cases of thumb defect were treated.The average age of these 9 patients was 26 years.The plane of thumb defect was class II area A to class III area A.According to the condition of thumb defect,designed the incision on the hallux and the second toe of the contralateral foot,and cut the 2nd digit and big-toe nail flap with a common arterial trunk.The nail of hallucis flap was rotated 90 degree and connected to the distal end of the 2nd toe.The hallucis flap covered the narrow neck of the 2nd toe.Thus,the circumference of the reconstructed finger and the length of the toenail were increased.Regular followed-up was made after operation.Results All 9 transplantation flaps survived,and donor sites healed primarily.Postoperative followed--up period ranged from 4 to 12(averge,7)months.All the reconstructed thumbs survived and donor toes were in satisfactory appearances.According to the Functional Assessment Criteria of the Upper Limb Formulated by the Hand Surgery Society of Chinese Medical Association,the outcomes were graded as excellent in 6 cases and good in 3 cases.All the patients were able to manage their daily activities independently.Donor toe injury was small,and their shape and function was good.Conclusion Free flap of second toe combined with hallucis can effectively improve the appearance of the reconstructed thumb.The appearance of the reconstructed thumb is symmetrical,beautiful,and the function is good.