摘要
目的探讨游离[足母]趾甲瓣组合第二足趾骨-关节复合组织瓣再造Ⅲ~Ⅴ度缺损拇指的临床效果。方法我科自2017年4月至2021年6月,以游离[足母]趾甲瓣组合第二足趾复合组织瓣再造Ⅲ~Ⅴ度拇指缺损患者12例,其中Ⅲ2度缺损7例,Ⅳ度缺损3例,Ⅴ1度缺损2例。Ⅳ度、Ⅴ度拇指缺损病例以第二跖趾关节重建拇指掌指关节,术中未予跖趾关节截骨或翻转。术后随访再造拇指外形、感觉、运动及供区恢复情况。结果本组12例再造拇指全部存活。术后随访12~24个月,所有再造拇指外形接近正常拇指,掌、指骨愈合良好,对掌、屈伸功能满意,指体两点分辨觉0.8~1.5 cm,所有病例供足外形良好,不影响负重、行走。再造拇指功能按中华医学会手外科学会手功能评分:优4例,良6例,可2例。结论应用游离[足母]趾甲瓣组合第二足趾骨-关节-肌腱复合组织瓣再造Ⅲ~Ⅴ度缺损拇指,选择合适的血管蒂可为复合组织瓣提供足够的血供,经过术中良好的神经缝合及术后早期科学的康复锻炼,再造拇指萎缩较少,可获得满意的外观功能。
Objective To explore the clinical efficacy of using free toenail flap combined with second toe bone-joint composite tissue flap to reconstruct degreeⅢtoⅤthumb defects.Methods From April 2017 to June 2021,a combination of free toenail flap and second toe composite tissue flap was used to reconstruct 12 patients with degreeⅢtoⅤthumb defects,including 7 cases of degreeⅢ2 defects,3 cases of degreeⅣdefects,and 2 cases of degreeⅤ1 defects.In cases of degreeⅣandⅤthumb defects,the second metatarsophalangeal joint was used to reconstruct the metacarpophalangeal joint of the thumb.No metatarsophalangeal joint osteotomy or flipping was performed during the surgery.The shape,sensation,movement,and donor site recovery of the reconstructed thumb were followed up after surgery.Results All 12 cases of thumb reconstruction in this group survived.The postoperative follow-up ranged from 12 to 24 months.All reconstructed thumbs had a similar appearance to normal thumbs,with good healing of the metacarpal and phalangeal bones,satisfactory opposition,flexion and extension functions,and a two-point discrimination of the finger body being 0.8 to 1.5 cm.In all cases,the donor foot had a good appearance and weight-bearing or walking unaffected.According to the hand function score of the Hand Surgery Society of the Chinese Medical Association,there were 4 cases of excellent,6 cases of good,and 2 cases of fair.Conclusion The combination of free toenail flap and second toe bone-joint-tendon composite tissue flap can be used to reconstruct a degreeⅢtoⅤthumb defect.Choosing a suitable vascular pedicle can provide sufficient blood supply for the composite tissue flap.Through good intraoperative nerve suturing and early postoperative scientific rehabilitation exercise,the reconstructed thumb has less atrophy and can achieve satisfactory appearance and function.
作者
董书男
刘承伟
江吉勇
黄东
彭龙
关翰辉
Dong Shunan;Liu Chengwei;Jiang Jiyong;Huang Dong;Peng Long;Guan Hanhui(Department of Upper Limb Repair and Reconstruction,Guizhou Hospital,Beijing Jishuitan Hospital,Guiyang 550000,China;The First Clinical Medical College of Guangxi Medical University,Nanning 530000,China;Department of Hand Surgery,Guangzhou Heping Orthopedic Hospital,Guangzhou 510317,China)
出处
《中华手外科杂志》
CSCD
北大核心
2024年第2期170-174,共5页
Chinese Journal of Hand Surgery
关键词
拇指
治疗结果
组合再造
第1跖背动脉
[足母]趾甲瓣
Thumb
Treatment outcome
Combined reconstruction
The first dorsal metatarsal artery
Toenail flap
