摘要
目的探讨应用游离的第2足趾近侧趾骨间关节复合组织移植再造手指指骨间关节缺损,同期采用趾近节腓侧带蒂骨皮瓣转移修复第2趾趾骨间关节供区缺损的临床疗效。方法从2020年12月至2023年4月,顺德和平外科医院手显微外科收治手指指骨间关节缺损患者共9例9指,男7例,女2例,年龄18~55岁,平均31岁,采用游离的第2足趾近侧趾骨间关节复合组织移植再造手指指骨间关节缺损,同期采用趾近节腓侧带蒂骨皮瓣转移修复第2趾趾骨间关节供区缺损,指导适当的功能锻炼,术后8~12周拔除克氏针。通过门诊复查、电话及微信等对患者进行随访,对再造指骨间关节及供区足部的外观及功能恢复情况进行复查,用中华医学会手外科学会关于拇和手指再造功能评定试用标准、温哥华瘢痕量表评分(VSS)、美国足踝关节协会(AOFAS)足功能评分标准进行评估。结果随访6~30个月,9例患者术后再造指骨间关节均成活,外形完整、美观;再造的指骨间关节功能恢复良好,根据中华医学会手外科学会关于拇、手指再造功能评定试用标准,平均分12分,其中6例为优,2例为良,1例为可。术后足部供区趾及第2足趾外观及功能均恢复良好,用VSS评价供区第2足趾瘢痕平均为4分;供区的足部保留5个趾体,外形饱满、完整美观,根据AOFAS足功能评分标准,平均评分达到95分,均为优。结论应用游离第2足趾近侧趾骨间关节移植再造手指指骨间关节同期采用趾近节腓侧带蒂骨皮瓣转位修复供区,在修复指骨间关节缺损、恢复手指指骨间关节功能的同时修复足部供区的外观及功能,可获得良好的临床疗效。
ObjectiveTo investigate the clinical efficacy of transfer of a free segment of the proximal second toe interphalangeal joint composite tissue flap in reconstruction of defects of interphalangeal joint of fingers,and simultaneously reconstruct the donor site defect left with the second toe by a transfer of a pedicled bone flap of the fibular proximal great toe.MethodsFrom December 2020 to April 2023,a total of 9 patients with interphalangeal joint defects of fingers were treated in the Department of Hand Microsurgery of Shunde Heping Surgery Hospital.The patients were 7 males and 2 females,aged 18-55 years old,with an average age of 31 years old.Firstly,transfers of a free segment of the proximal second toe interphalangeal joint composite tissue flap were performed to reconstruct the defects of finger joints.Simultaneously in the surgery,transfers of the fibular pedicled bone flap of the proximal great toe were conducted to reconstruct the donor site defects left in the second toe.Patients were instructed with appropriate postoperative functional exercises.K-wires were removed at 8-12 weeks after surgery.Outpatient visits,telephone and WeChat follow-ups were conducted to evaluate the appearance and functional recovery of the reconstructed interphalangeal joints and donor feet.Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,Vancouver Scar Scale(VSS)and American Orthopedic Foot and Ankle Society(AOFAS)foot function scoring standards were employed in the evaluation.ResultsPostoperative follow-up lasted for 6 to 30 months.All of the 9 interphalangeal joint composite tissue flaps in the fingers survived with complete and good appearance.Function of the reconstructed interphalangeal joints of the fingers recovered well.According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,the average score achieved 12 points,with 6 patients of excellent,2 of good and 1 of fair.After surgery,the appearance and
作者
吴祥
彭松根
黄海燕
李胜山
刘敏
黎世洲
廖松南
郭桥鸿
张敬良
WU Xiang;PENG Songgen;HUANG Haiyan;LI Shengeshan;LIU Min;LI Shichou;LAO Songnan;GUO Qiaohong;ZHANG Jingliang(Deportment of Hand Microsurgery,Shunde Heping Surgery Hospital,Foshan,Guongedong Prouince 528308,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2024年第3期294-299,共6页
Chinese Journal of Microsurgery
关键词
骨皮瓣
指骨间关节
关节损伤
关节移植
足趾
再造
供区
Bone flap
Interphalangeal joint
Joint injury
Joint transfer
Toe
Reconstruction
Donor site
