摘要
目的介绍手指Ⅳ～Ⅵ度缺损的全形再造方法。方法自1998年12月至2010年12月，对手指Ⅳ度缺损63例85指，V度缺损31例49指，Ⅵ度缺损17例23指进行了手指全形再造。保留4个足趾的，躅甲瓣供区用2趾甲皮瓣修复；保留5个足趾的，躅甲瓣供区用皮瓣移位或移植来修复，第2足趾关节供区取髂骨充填。手指Ⅳ度缺损和部分V度缺损，采用躅趾腓背侧骨、趾甲、皮肤复合组织瓣，串1条髂骨再串第2趾近侧趾间关节的方法再造。部分近节指骨缺失长度较长的V度缺损手指，采用躅趾腓背侧骨、趾甲、皮肤复合组织瓣，串1条髂骨，再串第2趾近侧趾间关节，最后还要在近节指骨残端与移植的第2趾近侧趾间关节间再串1条髂骨的方法再造。Ⅵ度缺损的手指，采用以下顺序串连：躅趾腓背侧骨、趾甲、皮肤复合组织瓣，串1条髂骨，串第2趾近侧趾间关节重建手指近指问关节，串1条髂骨重建近节指骨，串第2跖趾关节重建掌指关节的方法再造。结果再造手指157指全部成活。平均随访7个月～11年，其中75指行二期整形手术。再造手指外形美观，再造指指腹两点辨别觉为5～12mm。67指行术后肌腱松解手术，再造指间关节活动度：伸-10°～10°，屈55°-100°，平均81°。结论手指Ⅳ度至Ⅵ度缺损全形再造，再造的手指兼具美观外形与良好运动功能，缺点是手术较复杂。
Objective To introduce the clinical application of full reconstruction for 72 cases of IV to VI-degree finger defect. Methods From December 1998 to December 2010, sixty-three cases （85 fin- gers） of IV-degree finger defect, thirty-three cases （49 fingers） of V-degree finger defect and 17 cases （23 fingers） with VI-degree finger defect were applied full reconstruction. The procedures of full reconstruction of IV to V-degree finger defect were as follows： Harvest part of nail, skin which includes some skin harvested from dorsal and palmar metatarsal to ensure the length of the reconstructed finger, and dorsal part of distal phalanx from hallux to form a composite flap, which constitute the contour of a finger, and harvesting inter- phalangeal joint from the second toes to reconstruct the proximal interphalangeal （PIP） joint. Bone transplan- tation from the iliac bone to the distal （for IV-degree and light V-degree defect） or both proximal and distal （for severe V-degree defect） stump of the reconstructed PIP joint was needed to get to an appropriate length. On the basis of the treatment of V-degree defect, reconstruction of VI-degree finger defect was to harvest one more joint： the metatarsophalangeal joint of the second toe, and connect it with the proximal iliac bone rod. Results About half of the cases were conserved of 4 toes, and the donor wound of halluxes were covered with the composite flaps （composed of nail, skin） harvested from the second toes which had been sacrificed. The other cases were conserved of all the 5 toes, and the donor wound of halluxes were covered by free flap transplantation. The second toes were reconstituted by bone transplantation from the iliac bones. All of the 157 fingers survived completely, and 75 fingers underwent second-stage plastic surgeries. Sixty-seven fingers underwent second-stage tenolysis surgeries. Follow-ups 7 months to 11 years after surgery, and all the recon- structed fingers had realistic configurations, and the two-point discrimin
出处
《中华显微外科杂志》
CSCD
北大核心
2011年第4期269-271,354,共4页
Chinese Journal of Microsurgery
关键词
指
再造
躅甲瓣
显微外科
Finger
Reconstruction
Hallux nail flap
Microsurgery
