趾末节增宽技术在手指全形再造中改善趾供区外形与功能的效果观察

Effect of widening the distal great toe on improving the shape and function of the donor site in finger reconstruction

目的探讨趾末节缓慢增宽技术在手指全形再造中改善趾供区外形与功能的效果。方法回顾性研究。纳入2020年9月—2021年8月在山东大学附属省立医院手足外科一期行趾末节增宽术、二期行甲骨皮瓣游离移植手指全形再造术的患者2例:男1例,19岁,右中指Ⅱ度缺损,一期行左趾末节增宽术,二期行左足甲骨皮瓣游离移植右中指全形再造术;女1例,36岁,右中指Ⅴ度缺损,一期行双足趾末节增宽、右中指骨延长术,二期行左足甲骨皮瓣游离移植右中指全形再造术。甲骨皮瓣供区旷置后延期行全厚皮片移植术。手指全形再造术后随访3~6个月,观察再造手指指骨愈合、成活情况及趾供区外观功能。结果 2例患者再造手指全部成活,指骨一期愈合,未发生骨不连和术后血管危象,趾供区趾甲宽度接近正常,趾外观饱满、功能无明显异常。结论趾末节缓慢增宽技术用于手指缺损全形再造,能保留趾供区较好的外观和功能,尤其是趾供区趾甲宽度接近正常。

Objective To investigate the effect of slowly widening the distal great toe on improving the shape and function of the donor site in finger reconstruction.Methods A retrospective study was conducted on two patients who underwent widening of the distal great toe before finger reconstruction in Shandong Provincial Hospital Affiliated to Shandong University between September 2020 and August 2021.A 19-year-old male patient with gradeⅡdefect of the right middle finger underwent widening of the distal great toe in the first stage and full reconstruction of the right middle finger with free osteo-onychocutaneous flap in the second stage.A 36-year-old female patient with grade V defect of the right middle finger simultaneously underwent widening of the distal great toe and lengthening of the right middle finger in the first stage and then full reconstruction of the right middle finger with free osteo-onychocutaneous flap in the second stage.The donor site was repaired by delayed full-thickness skin transplantation.The patients were followed up for 3-6 months after reconstruction.The healing of the phalanges,the survival of the reconstructed fingers,and the appearance and function of the great toes were evaluated.Results The reconstructed fingers of the two patients survived with primary bone healing and without nonunion or postoperative vascular crisis.The width of the toenail at the donor site was approximately normal,and the great toe had satisfactory appearance and normal function.Conclusions The slow widening of the distal great toe can preserve the appearance and function of the donor site,particularly toenail width,for patients who need finger reconstruction.