摘要
目的探讨应用携带部分末节趾骨的躅甲瓣联合髂骨植骨再造Ⅲ度缺损的拇指临床效果。方法2011年6月至2016年6月，对7例拇指Ⅲ度缺损患者应用携带末节部分趾骨的躅甲瓣联合髂骨植骨再造拇指。按程国良拇指缺损分度法，其中拇指Ⅲ度1型缺损4例，Ⅲ度2型缺损3例。供区植皮1例．游离旋髂浅动脉皮瓣移植修复5例，游离腓动脉穿支皮瓣修复1例，均保留足趾数量及长度。术后观察再造指功能、外形及感觉恢复情况；供区皮瓣或植皮成活情况，远期是否存在行走痛等。结果术后再造拇指全部成活．供区1例旋髂浅动脉皮瓣修复病例术后坏死，二期植皮成活。术后随访3～18个月，平均8个月。再造拇指质地、弹性良好，两点辨别觉4～10mm，平均6mm；拇指对掌及掌指关节屈伸功能良好，指甲平整、光滑，有光泽。供区躅趾植皮及皮瓣色泽、质地较满意，不影响行走及跑跳．无行走痛等不适。根据中华医学会手外科学会上肢部分功能评定试用标准，获优5例．良2例。结论应用携带部分末节趾骨的躅甲瓣联合髂骨植骨再造Ⅲ度缺损拇指，术后功能、外形良好；供区创伤小，保留足趾数量及长度，临床效果较好。
Objective To explore the clinical effect of using hallux-nail flap with the distal part of phalanx combined with iliac bone for reconstruction of thumb with III degree defect. Methods From June, 2011 to June, 2016, 7 patients with thumb III degree defect were treated with the hallux-nail flaps with distal phalanx combined with iliac bone to reconstruct thumbs. According to the thumb defect indexing method reported by Cheng Guoliang, the type 1 of thumb III degree defect was 4 cases, and the type 2 of III degree defect was 3 cases. The donor site was covered with skin grafting in 1 case, free superficial iliac artery graft in 5 cases and free peroneal artery perforator flap in 1 case. All patients kept the number and length of donor toes. Regular follow-up was performed after opera- tion to observe the function, shape, feeling of finger reconstruction, the survival condition of flaps or skin graft in donor site, etc. It was also observed if the pain by walking actually exists in the long-term effect. Results All of the reconstructed thumbs survived. One patient suffered the necrotic in the donor site repaired by superficial iliac artery flap, which was successfully covered with the skin graft. All patients were followed-up from 3 months to 18 months （mean, 8 months）. The reconstructed thumb with smooth nail had fine textile and good elasticity, good flexion and extension function of the palm, fingers and the metacarpophalangeal joint. The donor sites recovered with fine texture, and there were no difficulties in walking and running and no complaint about the pain and discomfort. Ac- cording to the Trial Criteria of Upper Limb Functional Evaluation of Chinese Medical Association Hand Surgery Soci- ety, 5 cases resulted in excellent, and 2 cases resulted in good. Conclusion The hallux-nail flap with the distal phalanx combined with iliac bone is an excellent option to reconstruct thumb with III degree defect with the outcome of good function and appearance. The trauma of the donor site is small and the number an
作者
李木卫
马立峰
张喆
黄少耿
梁勇
吴巩
杨延军
张子清
Li Muwei;Ma Lifeng;Zhang Zhe;Huang Shaogeng;Liang Yong;Wu Gong;Yang Yanjun;Zhang Ziqing(Depart- ment of Hand Microsurgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, Guangdong 518116, China)
出处
《中华显微外科杂志》
CSCD
北大核心
2018年第2期129-132,共4页
Chinese Journal of Microsurgery
基金
深圳市科创委项目（JCYJ20170307102125460）
关键词
拇指缺损
躅甲瓣
再造
显微外科
Thumb defect
Hallux-nail flap
Reconstruction
Microsurgery
