摘要
目的探讨采用无吻合血管趾骨甲皮瓣行指尖再造术的临床效果。方法2015年1月至2020年10月,东莞长安新安医院选择具备一定条件的指尖损伤患者,采用无吻合血管的趾骨甲皮瓣修复指尖缺损,供区创面直接缝合或皮瓣局部转移覆盖,该文对其临床资料进行了回顾性分析。采取门诊、电话、微信、登门拜访等方式随访患指外观及功能。采用中华医学会手外科学会拇手指再造功能评定试用标准对手部功能进行评定,并从4个方面对再造后甲床外观、功能进行评定。结果共纳入11例12指。男8例,女3例,年龄17~50岁,平均35.6岁。其中压砸(挤压、冲压)伤5例5指,切割伤3例3指,绞轧伤2例2指,化学腐蚀伤1例2指。拇指2例,示指7例,中指2例,环指1例,合并其他指损伤4例;均为甲根部以远的指尖缺损伤,其中甲半月以远缺损4指,甲中段以远缺损5指,甲远1/3平面以远缺损3指。择期手术7例,急诊手术4例。指骨、甲、皮瓣(指腹)缺损长度:0.2 cm/0.5 cm/0.5 cm~0.6 cm/0.8 cm/1.0 cm。切取趾骨甲皮瓣(趾腹)大小:0.2 cm/0.5 cm/0.7 cm~0.6 cm/0.8 cm/1.0 cm。指腹缺损长度均≤1.0 cm。随访时间6~30个月,平均12.5个月,再造指尖均成活,再造指尖外观饱满红润,指甲较平整。足供区无功能影响。移植骨瓣愈合时间1.5~3.0个月,平均2.1个月。指功能评定优7例,良4例;甲床外观与功能评定优6指,良5指,差1指。结论无吻合血管趾骨甲皮瓣再造指尖,手术简单,疗效可靠。
Objective To investigate the clinical effect of fingertip reconstruction using the toenail osteocutaneous flap without vascular anastomosis.Methods From January 2015 to October 2020,the clinical data of patients with fingertip injuries were analyzed retrospectively,which were treated with the toenail osteocutaneous flap without vascular anastomosis in Chang’an Xin’an Hospital.The donor site was closed primarily or covered by a local flap.The appearance and function of the patients’fingers were followed up.All cases were evaluated by the standard of thumb finger reconstruction function evaluation of the Chinese Medical Association of Hand Surgery.Appearance and function of nail bed after reconstruction was evaluated from four aspects.Results A total of 11 cases(12 fingers)were enrolled,including eight males and three females.The average age was 35.6 years(range,17-50 years).The etiologies included crush-related injury,cutting injury,mangled injury,and chemical corrosion injury.The injuries were found in thumb,index finger,middle finger,ring finger,or combined with multiple fingers.All fingertip defects were located distal to the nail root,including the defects distal to lunula in four cases,the defects distal to middle of the nail in five fingers,and the defects distal to 1/3 of the nail in three cases.Elective surgery was performed in 7 cases and emergency surgery in 4 cases.The defects ranged from 0.2 cm/0.5 cm/0.5 cm to 0.6 cm/0.8 cm/1.0 cm(phalanx/nail/finger pulp).The size of the toenail osteocutaneous flap ranged from 0.2 cm/0.5 cm/0.7 cm to 0.6 cm/0.8 cm/1.0 cm(phalanx/nail/flap).The defects length of the finger pulp were less than 1.0 cm.All reconstructed fingers survived,and the follow-up was 6-30 months(average,12.5 months).The appearances of the reconstructed fingers were pulmp and ruddy,and the nails were flat.There was no dysfunction in the donor site.The average healing time of bone was 2.1 months(range,1.5-3.0 months).According to the evaluation of index function,seven cases were excellent,fou
作者
梅雄军
魏义涛
梁海华
钟桂午
孙芳芹
Mei Xiongjun;Wei Yitao;Liang Haihua;Zhong Guiwu;Sun Fangqin(Department of Hand and Foot Microsurgery,Chang’an Xin’an Hospital,Dongguan 523880,China;Department of Orthopedics,North District,Air Force Medical Center,PLA,Beijing 100089,China)
出处
《中华整形外科杂志》
CSCD
2021年第12期1370-1377,共8页
Chinese Journal of Plastic Surgery
基金
东莞市社会科技发展面上项目(20211800901982)。
关键词
手损伤
趾骨甲皮瓣
指尖
再造
无血管技术
Hand injuries
Phalanx,toenail and flap
Fingertip
Reconstruction
Non vascular technique
