摘要
目的探讨拇、手指末节部分缺损的修饰性再造的临床疗效。方法 2018年1月-2021年1月,兵器工业卫生研究所(兵器工业五二一医院)手外科收治129例拇、手指末节部分缺损伴骨或(和)肌腱外露的患者,男111例,女18例,平均年龄34(17~59)岁。甲基质缺损0.4 cm×1.1 cm~1.8 cm×2.0 cm,骨缺损长度0.4~1.8 cm,软组织缺损1.6 cm×1.8 cm~3.2 cm×4.8 cm,采用清创游离趾组织瓣修复拇、手指末节部分缺损。77例趾腓侧皮瓣供区中17例直接关闭创面,60例缩小创面后10例采用植皮、28例采用人工真皮覆盖创面、22例采用横行"V-Y"推进皮瓣修复创面。52例甲瓣供区创面中49例采用人工真皮修复、3例趾甲基质全部缺损采用游离腓动脉穿支皮瓣修复。门诊随访,随访截止时间至2022年7月,随访内容包括:皮瓣有无坏死,皮瓣外形、纹理、质地,再造拇、手指甲板外观,再造拇、手指指腹TPD,皮瓣瘢痕及对冷耐受性,再造拇、手指屈伸功能,X线片评价再造拇、手指指骨骨愈合时间;供区趾外观、感觉、对冷的耐受性及供区足部运动功能。结果术后随访平均21(18~24)个月,术后128例皮瓣成活,1例趾腓侧皮瓣发生皮瓣坏死,通过指掌侧固有动脉逆行岛状皮瓣修复,皮瓣愈合良好。再造拇手指外形、纹理、质地及甲板与健侧拇、手指接近。再造拇、手指参照Zook指甲修复评定标准,优127例,良2例。再造拇、手指指腹TPD为4~10 mm,用温哥华瘢痕量表评分(VSS)评价再造拇、手指的瘢痕平均为0.6分,用视觉模拟量表(VAS)评价再造拇、手指对冷的耐受性平均为0.3分,所有患者再造拇、手指屈伸功能恢复良好,手功能按中华医学会手外科学会上肢部分功能评定试用标准,优127例,良1例,中1例。所有患者X线片示拇、手指指骨均骨性愈合,平均愈合时间为术后2个月,无骨吸收、感染、骨不连及应力性骨折。供区趾长度与对侧趾无差别。除了趾甲�
Objective To explore the clinical effect of cosmetic reconstruction for partial defect of distal segment of digits.Methods Form January 2018 to January 2021,the Department of Hand Surgery of Institute for Hygiene of Ordnance Industry(The 521 Hospital of Weapon Industry)admitted 129 patients with partial defect of distal segment of thumb or fingers with phalange or tendon exposure.The patients were 111 males and 18 females with an average age of 34(17-59)years old.The sizes of nailbed defect were 0.4 cm×1.1 cm-1.8 cm×2.0 cm,the length of phalange defect was 0.4-1.8 cm,and the sizes of the soft tissue defect were 1.6 cm×1.8 cm-3.2 cm×4.8 cm.Great toe tissue flaps were used to reconstruct the partial defect of distal segment of thumb or fingers after debridement.Wounds of fibular flap of great toe in 77 cases were directly sutured in 17 patients.The donor sites in rest 60 great toes were narrowed first and then repaired with skin grafts in 10 cases,with artificial dermis in 28 cases and with transverse V-Y advancement flaps of ipsilateral great toes for 22 cases.Forty-nine of 52 donor site wounds for hallux toenail flap were repaired with artificial dermis and 3 with free peroneal artery perforator flaps.The method was outpatient follow-up.Postoperative follow-up lasted until July 2022.The check-items for follow-up included:occurrence of necrosis,appearance,shape and texture of the flap,appearance of the reconstructed nails,TPD of the reconstructed digit pulps,tolerance to cold on the scars of flaps,flexion and extension of the reconstructed digits.The healing time of phalanges of the reconstructed digits was evaluated by X-rays.The appearance,sensation,the tolerance to cold of great toe and the movement of donor foot were also assessed.Results Postoperative follow-up lasted for 18 to 24 months,with an average of 21 months.A total of 128 flaps survived.Necrosis occurred in 1 fibular hallux flap,the necrosis was cured with a reverse digital proper artery island flap.Thereafter,all flaps healed well.The appearance
作者
董俊文
梁高峰
程永涛
张明明
权小波
贾宗海
张满盈
张朝
滕云升
郭永明
DONG Junwen;LIANG Gaofeng;CHENG Yongtao;ZHANG Mingming;QUAN Xiaobo;JIA Zonghai;ZHANG Manying;ZHANG Chao;TENG Yunsheng;GUO Yongming(Department of Hand Surgery,Institute for Hygiene of Ordnance Industry(The 521 Hospital of Weapon Industry),Xi'an 710065,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第1期57-63,共7页
Chinese Journal of Microsurgery
基金
陕西省重点研发计划(一般项目-社会发展领域)(2022SF-344)。
关键词
拇指
手指
修饰性再造
趾
显微外科技术
Thumb
Finger
Cosmetic reconstruct
Great toe
Microsugical techniqe
