游离第二足趾移植联合股前外侧穿支皮瓣重建手功能

Free second toe graft combined with anterolateral perforator thigh flap to reconstruct hand function

目的探讨游离第二足趾移植再造拇手指并联合股前外侧穿支皮瓣修复创面重建手功能的临床效果.方法自2019年1月至2022年12月,我们应用游离第二足趾移植再造拇手指并联合股前外侧穿支皮瓣修复手部残存创面重建手功能9例,其中拇指缺损伴创面存留1例,第2~5指缺损伴创面存留6例,第3~5指缺损伴创面存留1例,示环小指缺损伴创面存留1例,手部残存创面大小为9.0 cm×6.0 cm~18.0 cm×10.0 cm.术后观察再造指体及皮瓣存活情况,定期随访再造指体活动度、力量、感觉及手使用情况,皮瓣外形、感觉及供区功能、外形恢复情况.结果本组9例再造指体及皮瓣全部存活.术后随访时间为6~18个月,平均8个月,再造指体及皮瓣血运良好,再造指体感觉恢复S3~S4,外形满意;皮瓣质地良好,2例外形稍臃肿,7例外形满意,感觉恢复S2~S3.足部及大腿供区遗留线性瘢痕,下肢行走功能正常.根据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例,良5例,可1例.结论应用游离第二足趾移植再造拇手指,联合游离股前外侧穿支皮瓣修复手部残存创面重建手功能,可恢复手部抓捏握持功能,效果满意,是一种手毁损伤理想的修复方法。

Objective To explore the clinical efficacy of free second toe transplantation for reconstruction of thumb and finger,combined with anterolateral perforator thigh flap for wound repair and hand function reconstruction.Methods From January 2019 to December 2022,we used free second toe transplantation to reconstruct the thumb finger and combined it with anterolateral perforator thigh flap to repair residual wounds in the hand and reconstruct hand function in 9 cases.Among them,there was 1 case of thumb defect with wound preservation,6 cases of 2nd to 5th finger defect with wound preservation,1 case of 3rd to 5 th finger defect with wound preservation,and 1 case of ring finger defect with wound preservation.The size of the residual wound in the hand was 9.0 cm×6.0 cm to 18.0 cm×10.0 cm.The survival of the reconstructed finger and skin flap after surgery was observed,and the activity,strength,sensation,and hand use of the reconstructed finger,as well as the appearance,sensation,donor function,and recovery of the skin flap were followed up regularly.Results All 9 cases of reconstructed finger bodies and skin flaps in this group survived.The postoperative follow-up time was 6 to 18 months,with an average of 8 months.The blood supply of the reconstructed finger and skin flap was good,and the sensation of the reconstructed finger was restored from S3 to S4.The appearance was satisfactory.The texture of the skin flap was good,with 2 cases being slightly swollen in shape,7 cases having satisfactory appearance,and a sensation recovery of S2 to S3.The linear scars were left in the foot and thigh donor areas,and the walking function of the lower limbs was normal.According to the evaluation criteria of the Chinese Society of Hand Surgery for thumb and finger reconstruction function,there were 3 cases of excellent,5 cases of good,and 1 case of fair.Conclusion The application of free second toe transplantation to reconstruct thumb and finger,combined with free anterolateral perforator thigh flap to repair residual wounds in the hand and reconstruct hand function,can restore hand grasping and gripping function with satisfactory results,and is an ideal repair method for hand injuries.