吻合趾底动脉的足拇趾腓侧皮瓣修饰性修复手指指腹缺损

Repair of finger pulp defect with the great toe fibular skin flap by vascular anastomoses of plantar digital arteries

目的探讨应用吻合趾底动脉的足拇趾腓侧皮瓣修饰性修复手指指腹缺损的治疗方法和临床效果。方法自2014年3月至2019年3月,应用吻合趾底动脉的足拇趾腓侧皮瓣移植的方法,对东部战区总医院秦淮医疗区收治的21例手指指腹缺损患者进行修复。术后按功能活动度、再造指力量、感觉测定、手使用情况进行评定。结果20例皮瓣均一期成活。1例皮瓣出现血管危象,经手术探查,皮瓣成活。足拇趾供区或直接缝合或植皮修复。术后随访3~12个月,皮瓣质地良好,两点辨别觉为4~6 mm,手指外观及功能恢复满意,按中华医学会手外科学会上肢功能评定标准评价:优19例,良1例,可1例,优良率为95.2%。足拇趾外观良好,行走等不受影响。结论足拇趾腓侧皮瓣感觉恢复良好、外形逼真、带罗纹,达到修饰性修复目的,且对足部供区影响小,是修复手指指腹缺损的理想皮瓣。

Objective To explore the clinical effects of repair of finger pulp defect with lateral flap of the great toe,which anastomoses the artery of the base of the toe.Methods From March 2014 to March 2019,21 cases of finger pulp defects were repaired by transplantation of fibular flap of great toe at Qinhuai Medical Area,General Hospital of the Eastern Theater.The functional range of motion,strength,sensory measurement and hand use of reconstructed finger were evaluated after operation.Results Twenty flaps survived without complications.One case had vascular crisis,the flap survived after surgical exploration.The donor sites were directly sutured or repaired by skin grafting.The period of follow-up ranged from 3 to 12 months.The appearance and function of the reconstructed fingers were satisfactory,and the twopoint discrimination was 4 to 6 mm.According to the Chinese Medical Association on the assessment of the function of the upper limb standard,the results were excellent in 19 cases,good in 1 case,fair in 1 case,the excellent and good rate was 95.2%.The appearance of the toe was good,and walking was not affected.Conclusion The lateral flap of the great toe has good sense recovery,lifelike appearance and rib pattern,so as to achieve the purpose of modified repair,and has little effect on the donor area of the foot.The fibular flap is an ideal flap for the repair of finger pulp defect.