游离第2足趾骨关节复合组织与趾皮瓣组合桥接再造修复单指节段性缺损断指

Segmentle bridging reconstruction in severed segmental defect of finger by the free second toe hand-joint composite tissue combined with the flap of great toe

目的介绍采用游离第2足趾骨关节复合组织与趾皮瓣组合桥接再造修复单指节段性缺损断指的手术方法及疗效。方法自2010年6月至2017年9月,对5例节段性缺损断指,根据其骨关节、血管、神经、肌腱及软组织缺损的情况,分别设计并切取以第1跖背动脉或趾底动脉为蒂第2足趾骨关节复合组织与趾腓侧"C"形或半月形皮瓣,组合后形成Flow-through桥接复合组织体,吻合一套血管蒂即可再造重建缺损指段并恢复远端断指血供。足部趾供区行植皮、逆行跗外侧皮瓣或游离穿支皮瓣修复,第2足趾行残端修整或植入髂骨条予以保趾,4~6周左右拔出手指内固定克氏针,开始功能锻炼。结果 5例组合桥接指段(Flow-through桥接复合组织体)及远端断指均完全成活,骨折于术后8~12周愈合。5例均行门诊随访,随访时间6~36个月,指体外形与健侧相近,桥接再造指骨间关节主动屈曲最大可达60°,同时有适度背伸,按中华医学会手外科学会拇、手指再造功能评定试用标准评定:优3指,良2指。足部行走无明显影响。结论采用游离第2足趾骨关节复合组织与趾皮瓣组合桥接再造修复单指节段性缺损断指,在桥接再造毁损指段同时恢复远端指体血供,指体功能及外形恢复良好,是节段性复合组织缺损断指较理想的修复方式。

Objective To explore a surgical technique and treatment outcomes of the segmentle bridging reconstruction for severed fingers with single segmentle defect by using the free second toe bone-joint composite tissue combined with the great toe flap.Methods From June 2010 to September 2017,5 patients suffered from severed segmental defect of finger were treated.According to the defects of bone-joints,blood vessels,nerves,tendons and other soft tissues,the reconstruction surgery was designed to create a Flow-through bridging composite flap pedicled with the first dorsal metatarsal artery or the plantar artery.The blood vessles carried by the pedicle were anastomosed with the vessels in the finger to restore the blood supply to the distal finger while having the defected finger segment reconstructed.A Flow-through bridging composite flap was created by taking the second toe bone-joint composite tissue combined with a C-shaped or half-moon shaped flap from the fibular side of the great toe.Skin graft,retrograde lateral tarsal flap or free perforator flaps were used in 3 cases to repair the donor sites of the great and second toes.Iliac strip was implanted in 2 cases for toe salvage.Kirschner wires were removed 4-6 weeks after surgery followed by functional exercise.Results All of the 5 reconstructed distal segments of the fingers survived with the healing of fractures in 8-12 week after surgery.The postoperative follow-up lasted 6-36 months and all the patients had the follow-ups at the outpatient clinic.It was found that the maximum flexion of the reconstructed interphalangel joint was 60 degrees together with dorsiflezion.According to the evaluation standard of the reconstructed function for thumb and finger issued by the Hand Surgery Society of the Chinese Medical Association,3 fingers were in excellent and 2 in good.No obviouse affect on walking was found in all the patients.Conclusion The free second toe joint composite tissue together with the great toe flap can be used to bridge the single segmental defect of a finger.It restores the blood supply to as well as the appearance of the distal finger,helps the recovery of the reconstructed distal finger.It is an ideal technique in the treatment of a severed distal segment of the finger.