游离双足 趾腓侧皮瓣修复相邻双指指腹缺损7例

Reconstruction of pulp defects of two neighbouring digits with free great toe fibular flaps of both feet:a study on 7 cases

目的:探讨应用双足 趾腓侧皮瓣修复相邻双指指腹缺损的临床效果。 方法:自2020年8月至2023年1月,周口淮海医院显微手足外科采用双足 趾腓侧皮瓣修复7例14指指腹缺损,男4例,女3例;年龄19~45岁,平均28岁。创面位于左手4例,右手3例;示、中指损伤3例,中、环指损伤2例,拇、示指损伤2例,软组织缺损面积为1.2 cm×1.5 cm~3.0 cm×2.5 cm,皮瓣切取面积为1.5 cm×1.8 cm~3.2 cm×2.8 cm。其中急诊修复1例,择期手术修复6例;皮瓣供区直接闭合,创缘缝合张力较大时于足底内侧切取中厚皮片移植。术后采用门诊复诊、微信联系定期随访,观察手指外形、感觉、功能恢复与皮瓣挛缩情况以及双足 趾活动情况。 结果:术后7例皮瓣均顺利成活,皮瓣供区甲级愈合。术后定期随访6个月~2年,平均9个月。皮瓣外形美观、感觉优良,TPD达3~6 mm,手指功能恢复满意。 趾皮瓣供区均只遗留线形瘢痕,关节活动度及行走步态正常。按中华医学会手外科学会上肢部分功能评定试用标准评定:优5例,良2例。 结论:应用双足 趾腓侧游离皮瓣是同期修复相邻双指指腹缺损的理想方法,可以达到良好的重建效果。

Objective To explore the clinical effect of using great toe fibular flaps of both feet on reconstruction of pulp defects of two neighbouring digits.Methods A total of 14 digit pulp defects in 7 cases were repaired in Zhoukou Huaihai Hospital using great toe fibular flaps of both feet from August 2020 to January 2023.Of the 7 cases,there were 4 males and 3 females,with an average of 28 years old,ranging from 19 to 45 years old.Meanwhile,there were 4 cases in left hand and 3 cases in right hand.There were 3 cases of digit pulp defects in index and middle fingers,2 in middle and ring fingers,and 2 in thumb and index fingers.The area of soft tissue defect in 1.2 cm×1.5 cm-3.0 cm×2.5 cm,and flap was 1.5 cm×1.8 cm-3.2 cm×2.8 cm.Furthermore,1 case underwent emergency surgery and 5 were repaired in elective surgery.The donor site of the flap was closed directly,and an intermediate-thickness skin graft was prepared from the medial plantar area for transfer in the case of high suture tension at the wound edge.After surgery,patients received postoperative by outpatient clinic and WeChat to observe the appearance,sensation,functional recovery and flap contracture of digits,as well as the movement of the great toes of both feet.Results After the surgery,all flaps in the 7 cases survived smoothly and the donor sites healed.All patients entered scheduled follow-ups postoperatively for 6 months to 2 years,with an average of 9 months.The flap showed an aesthetic appearance and excellent sensation,with a TPD of 3-6 mm,and satisfactory digit function.The donor site of the great toe fibular flap left linear scars only,without abnormality in range of motion and gait in walking.In addition,there were 5 in excellent and 2 in good according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Conclusion Application of great toe fibular flaps of both feet is an ideal option for the simultaneous repair of pulp defects of two neighbouring digits,which can achieve good reconstructive results.