带足背皮瓣的第二足趾再造拇指缺损并重建虎口

Reconstruction of the thumb and web space defect with the dorsal skin flap of the second toe

目的 探讨带足背皮瓣第二足趾再造拇指缺损并重建虎口的手术方法及临床疗效。方法 自2016年1月至2020年12月,苏州瑞华骨科医院手外科收治的15例(15指)不同程度拇指缺损及虎口皮肤缺损患者,根据大小及形状,设计带足背皮瓣的第二足趾再造拇指Ⅱ类A区及以上缺损并重建虎口。结果 15例(15指)再造指体及皮瓣均一期全部成活,无血管危象发生。随访12~20个月,再造拇指外形满意,虎口皮瓣无明显臃肿,虎口无挛缩,皮色正常,无色素沉着。再造拇指指端两点辨别觉10~14 mm,虎口皮瓣两点辨别觉12~14 mm,再造拇指各关节主动屈伸活动度约60°~90°。12例可对小指,1例可对中指,2例可对示指;10例可主动对掌,2例主动对掌活动受限,可被动对掌,3例主被动对掌活动欠佳。指甲生长良好,外观平整。按中华医学会手外科学会手指再植、再造功能评定试用标准评定为优12例,良1例,可2例,优良率为86.7%。足部供区切口均一期愈合,植皮无坏死,无疼痛,行走正常,外观满意。结论 采用带足背皮瓣的第二足趾再造拇指缺损并同期重建虎口,术后外形及功能满意,是较为理想的修复方法之一。

Objective To investigate the surgical method and clinical efficacy of reconstructing the thumb defect and the first web space using the dorsal skin flap of the second toe.Methods From January 2016 to December 2020,Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital according to the size and shape of different degrees of thumb defects and skin defects of the first web,the second toe with dorsal skin flap was designed to reconstruct 15 cases of thumbs classⅡ,zone A,above defects and the first web.Results All the reconstructed thumb and flaps of 15 cases survived in one stage without vascular crisis.Follow-up time was from 12 to 20 months,with an average of 16 months.The reconstructed thumb has a satisfactory appearance,with no obvious swelling in the web space flap,no contraction in the web space,normal skin color,and no pigmentation.The 2-PD of the thumb tip of the reconstructed thumb was from 10 to 14 mm,and the 2-PD of the first web flap was from 12 to 14 mm.The active flexion and extension range of the reconstructed thumb joint was about 60°to 90°.There were 12 cases of little finger opposition,1 case of middle finger opposition,2 cases of index finger opposition,10 cases of active opposition,2 cases of active opposition limited,and 3 cases of active and passive opposition limited,nail growth was good,the appearance was smooth.According to the evaluation criteria for finger replantation and reconstruction function of the Chinese Society of Hand Surgery,excellent 12 fingers,good 1 finger,fair 2 fingers,with an excellent rate of 86.7%.The incisions in the foot donor area all healed in stage I,with no necrosis or pain after skin grafting,normal walking,and satisfactory appearance.Conclusion It is a good method to use the second toe with dorsal foot flap to reconstruct the thumb and first web space defect,with a satis-factory postoperative appearance and function.