趾C形Flow-through皮瓣在皮肤缺损断指再植中的应用

Application of great toe C-shaped flow-through flap for replantation of severed finger with skin defects in emergencyoperation

目的 探讨利用游离趾C形皮瓣在修复重建皮肤缺损断指再植中的应用效果及手术技巧.方法 自2019年1月至2023年12月,我们对9例手指离断合并皮肤软组织、指固有动脉、指神经节段性缺损的患者,采用游离趾C形Flow-through皮瓣桥接重建指端感觉及血运的同时,覆盖创面,保留指体长度.术后定期随访,观察手指及足趾外观及功能.结果 术后9例患者断指及皮瓣存活良好,随访时间为6~24个月,平均9个月.断指较健侧指体短缩0~1.5 cm,末次随访皮瓣外形良好,皮瓣两点分辨觉为7.5~10.5 mm,指端两点分辨觉为6.3~10.5 mm.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3例,差1例.患者对手指外观满意.结论 游离趾C形Flow-through皮瓣可以一期重建手指血运并覆盖创面,能有效保留指体长度,是治疗此类特殊类型断指再植的有效方法.

Objective To investigate the clinical efficacy and surgical techniques of the free great toe C-shape flap for repair of replanted severed finger associated with skin defects by using flow-through technique.Methods Between January 2019 and December 2023,9 patients with replanted severed finger combined with segmental defects in skin and soft tissue,proper digital artery,and digital nerve were repaired by free great toe C-shape flap.The defects of digital artery and nerve were reconstructed by flow-through technique,while covering the wound and preserving the length of finger.The appearance and function of injured hand and donor foot were followed postoperative.ResultsAll replanted finger and C-shape flaps were survived finally.All patients were follow-up from 6 to 24 months with an average of 9 months.The injured fingers were shorten O to i.5 cm compared to non-injured fingers.The skin flap had a good appearance during the last follow-up,with a two-point discrimination of flap being 7.5 to 10.5 mm and of fingertip being 6.3 to 10.5 mm.According to the evaluation criteria of the Chinese Society of Hand Surgery for upper limb function,there were 5 cases of excellent,3 cases of good,and 1 case of poor.The patient was satisfied with the appearance of their fingers.Conclusion The free great toe C-shape flow-through flap can reconstruct the blood supply of the finger at one stage and cover the wound,effectively preserving the length of the finger body.It is an effective method for treating the replantation of this special type of severed finger.