足底内侧皮瓣联合[足母]甲骨皮瓣在手指V度缺损再造中的临床应用

Clinical application of combined medial plantar flap and hallux nail bone flap in the reconstruction of Grade V finger defects

目的探讨采用足底内侧皮瓣联合[足母]甲骨皮瓣全形再造手指V度缺损,并应用腹部皮瓣修复足部供区的手术技术和疗效。方法2017年12月至2022年12月山东省公共卫生临床中心修复重建外科和山东第一医科大学附属省立医院手足外科采用足底内侧皮瓣联合[足母]甲骨皮瓣再造手指V度缺损26例,术中采用足底内侧皮瓣联合[足母]甲骨皮瓣包绕足第2趾骨近趾间关节,通过串联髂骨调整近趾间关节位置及指骨长度,多组织复合全形再造长手指。供足全部保留5趾,[足母]甲骨皮瓣供区采用游离腹股沟皮瓣或皮片移植修复,足第2趾骨近趾间关节供区采用髂骨移植填充修复,足底内侧皮瓣供区全厚植皮修复。结果26例再造手指全部成活。术后随访6~24个月,再造手指外形满意,感觉功能恢复至S3以上;足部供区各趾长度无缺失,足趾饱满度接近健侧,除[足母]趾甲床部分缺失外,其余整体外观理想。术后6~8周拔出克氏针进行适度功能锻炼,术后3个月复查骨折均达到骨性愈合。再造手指指间关节活动度:伸直-10°~5°,屈曲30°~90°,平均指间关节活动度65°。结论利用足底内侧皮瓣联合[足母]甲骨皮瓣全形再造手指V度缺损,既可以再造出外形满意、功能良好的长手指,又尽可能减小足部和肢体供区损伤,保留了足趾的长度及饱满度,是手指V度缺损再造的一种理想方法。

Objective To explore the surgical technique and effectiveness of using a combination of the hallux nail bone flap and the medial plantar flap for the reconstruction of Grade V finger defects,along with the use of groin flap for repairing the foot donor area.Methods From December 2017 to December 2022,the Department of Reconstructive Surgery at Shandong Public Health Clinical Center,along with the Department of Hand and Foot Surgery at Shandong Provincial Hospital Affiliated to Shandong First Medical University,managed 26 cases of grade V finger defects using a reconstructive approach that involved the use of a medial plantar flap combined with a hallux nail bone flap.During surgery,the medial plantar flap was combined with the hallux nail bone flap from the great toe to wrap around the proximal interphalangeal joint flap of the second toe.By connecting appropriate lengths of iliac bone grafts,the position of the proximal interphalangeal joint and the length of the finger bone could be adjusted,a multi-tissue composite was used to achieve the full reconstruction of a longer finger.All five toes were preserved in the donor foot.The donor site of the hallux nail bone flap was repaired using either a free groin flap or skin grafting.The defect in the proximal interphalangeal joint donor area of the second toe was filled and repaired with iliac bone transplantation.The donor site of the medial plantar flap was covered with full-thickness skin grafting.Results All 26 reconstructed fingers had successful outcomes.Postoperative follow-up ranged from 6 to 24 months.The appearance of the reconstructed fingers was satisfactory,and sensory function recovered to at least level S3.There was no loss of length in the toes of the donor foot,and the fullness of the toes approached that of the healthy side.Apart from partial loss in the hallux nail bed,the overall of the hallux appearance was ideal.Six to eight weeks after the operation,the Kirschner wire within the reconstructed finger was removed to allow for moderate functional exercises.Three months post-surgery,subsequent examinations indicated that the fracture lines in the reconstructed fingers had uniformly achieved osseous union.The reconstructed fingers displayed a range of motion in the interphalangeal joints as follows:extension from-10°to 5°,and flexion from 30°to 90°,with an average range of motion of 65°for the interphalangeal joints.Conclusion Utilizing medial plantar flap in conjunction with hallux nail bone flap for the full reconstruction of Grade V finger defects not only achieves a satisfactory appearance and excellent function for longer fingers,but also minimizes damage to the foot and limb donor areas.It preserves toe length and fullness,making it an ideal method for the reconstruction of Grade V finger defects.