摘要
目的探讨改良甲复合组织瓣修复含指间关节的拇指背侧复合组织缺损的方法及临床疗效。方法2007年1月-2013年6月,应用改良甲皮瓣携带骨质、肌腱及趾间关节囊移植修复14例(14指)木工机械所致的含指间关节的拇指背侧复合组织缺损。患者均为男性;年龄19~52岁,平均30岁。伤后至入院时间0.5~2.0 h,平均1.2 h。拇指背侧指甲、皮肤缺损范围为2.5 cm×1.5 cm^5.0 cm×2.5 cm;指间关节背侧伴不同程度骨缺损,掌侧部分骨质及关节囊尚存,骨缺损长度2.5~4.0 cm,平均3.4 cm。甲皮瓣切取范围3.0 cm×2.0 cm^6.0 cm×3.0 cm。供区采用植皮(5例)或第2跖背动脉逆行岛状皮瓣(9例)修复。结果术后1例甲皮瓣发生动脉危象,其余甲皮瓣均顺利成活,创面Ⅰ期愈合。供区3例植皮出现液化坏死,其余植皮及第2跖背动脉逆行岛状皮瓣顺利成活。患者均获随访,随访时间9个月~3年6个月,平均23个月。4例因甲复合组织瓣局部稍臃肿,6个月后行二期整形;其余甲复合组织瓣外观、颜色、质地满意。12例再造拇指指甲生长良好,2例稍增厚。末次随访时,X线片复查示,12例包含趾近节趾骨头部移植者,移植骨与拇指近节指骨近端愈合良好,供区趾趾间关节融合后愈合良好。末次随访时,按中华医学会手外科分会拇、手指再造功能评定试用标准评价,获优12例,良2例,优良率100%。供足均行走良好,无疼痛。结论改良甲复合组织瓣移植修复含指间关节的拇指背侧复合组织缺损能有效改善损伤拇指的外观及功能。
Objective To explore a new improved technique and its effectiveness to repair dorsal thumb composite tissue defects including interphalangeal joint by transplantation of modified hallux toe-nail composite tissue flap. Methods The hallux toe-nail composite tissue flap carrying distal half hallux proximal phalanx, extensor hallucis longus, and interphalangeal joint capsule were designed and applied to repair the dorsal skin, nails, and interphalangeal joint defect of thumb in 14 cases between January 2007 and June 2013. They were all males, aged from 19 to 52 years（mean, 30 years）. The time from injury to hospital was 0.5-2.0 hours（mean, 1.2 hours）. The area of the thumb nail and dorsal skin defects ranged from 2.5 cm×1.5 cm to 5.0 cm×2.5 cm. The dorsal interphalangeal joint had different degrees of bone defect, with residual bone and joint capsule at the palm side. The length of bone defect ranged from 2.5 to 4.0 cm（mean, 3.4 cm）. The hallux nail flap size ranged from 3.0 cm×2.0 cm to 6.0 cm×3.0 cm. The donor sites were repaired by skin grafting in 5 cases, and retrograde second dorsal metatarsal artery island flap in 9 cases. Results After operation, arterial crisis occurred in 1 case and the flap survived after relieving pressure; the other flaps survived, and wounds healed by first intention. Liquefaction necrosis of the skin grafting at donor site occurred in 3 cases, and the other skin grafting and all retrograde second dorsal metatarsal artery island flaps survived. The follow-up ranged from 9 months to 3 years and 6 months（mean, 23 months）. The secondary plastic operation was performed in 4 cases at 6 months after operation because of slightly bulky composite tissue flaps. The other composite tissue flaps had good appearance, color, and texture. The growth of the nail was good in 12 cases, and slightly thickened in 2 cases. At last follow-up, X-ray examination showed that bone graft and proximal phalanx of the thumb had good bone healing in 12 cases. Good bone healing was obtained at the
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第11期1415-1418,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
广东省医学科学技术研究基金项目(A2012674)~~
关键词
甲复合组织瓣
拇指
复合组织缺损
创面修复
Hallux toe-nail composite tissue flap
Thumb
Composite tissue defect
Wound repair
