改良[足母]甲瓣组合部分第2足趾游离移植全形再造拇指

Comprehensive reconstruction of thumb by transplanting partial second toe combined with hallucis flap

目的介绍一种切取部分第2足趾与[足母]甲瓣瓦合移植、改良再造拇指外观的手术方法。方法自2015年4月-2019年12月,切取部分第2足趾与[足母]甲瓣组合移植改良再造拇指12例,平均年龄28.5岁,拇指缺损平面III^V度。根据拇指缺损情况,于同侧足第1、2足趾设计切口,切取共干的第2足趾部分组织和[足母]甲瓣,将切取的[足母]甲瓣横向移位与第2足趾瓦合,弥补再造指诸多足趾特征及缺陷。供区第2足趾剩余软组织组合覆盖[足母]趾创面。定期随访。结果临床应用12例,供、受区创口一期闭合。经6~26(平均14)个月随访(门诊随访),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9例,良3例。所有患者生活自理,供区足部外形、功能良好。结论部分第2足趾瓦合[足母]甲瓣移植再造拇指缺损的手术方式能够有效的改善足趾外观,再造指外形逼真、美观,功能较好。

Objective To introduce an improved method for reconstruction of thumb by transplanting partial second toe combined with hallucis flap.Methods Since April,2015 to December,2019,12 thumbs were reconstructed by transplanting partial second toe combined with hallucis flap.The average age of the patients was 28.5 years old.The severity of thumb defect was grade III-V.The compound tissue flap of common vascular pedicle was obtained from the hallux and the partial second toe of the contralateral foot,according to the condition of the defect of thumb.The hallucis flap was rotated transversely and connected with the partial second toe.Make up the characteristics and defects for the reconstructed thumb.The remaining skin and soft tissue of the second toe and the donor area were tiled to cover the wound.The patients were followed-up regularly.Results All of the 12 transplantations completely survived.Postoperative follow-up period ranged from 6 to 26 months,14 months in average.Appearances of all reconstructed thumbs and the donor toes was satisfactory.According to the Functional Assessment Criteria of the Upper Limb set by the Hand Surgery Society of Chinese Medical Association,the outcomes were graded excellent in 9 cases and good in 3 cases.All patients were able manage daily activities and living independently.Shape and function of donor foot were good.Conclusion Part of the second toe combined with the hallucis flap transfer for thumb reconstruction may effectively improve the appearance of the reconstructed thumb.The reconstructed thumb is symmetrical,good in shape and satisfactory in function.