足趾组织移植拇手指再造与修复的进展

1966年杨东岳首先选用第二趾移植施行拇指再造获得成功,建立了再造外科的丰碑。相继有Cobbett(1968)、Buncke(1973)、Tamai(1974)选用邰趾移植再造拇指获得成功的个案报道。随着显微外科技术的发展和提高,最初由单纯粗放型的拇指再造发展到现在施行的精细修饰性再造与修复,使再     

足趾移植再造拇手指

我院于1985年～2002年3月收治拇指及手指缺失患者143例159指,经行足趾移植再造术后疗效满意,现报道如下。1资料与方法1.1一般资料本组143例159指,其中男113例,女30例;年龄6～69岁,平均25岁。采用足趾移植方法再造拇手指,其中急诊再造69指,择期90指。1.2手术方法麻醉方式为臂丛加硬膜外麻醉,有时取足趾时采用局麻。手术一般分两组,即手组及足组。1.2.1传统术式手组:找出残端伸屈肌腱、两侧指神经,在鼻烟窝处找出桡动脉、头静脉。足组:在踝下十字韧带处找出足背动脉,向远端游离找出跖背动脉、趾动脉。跖背动脉按Gilbert分Ⅲ型:Ⅰ型,第一跖背…     

足趾移植再造拇手指的设计

目前，足趾移植再造拇手指的方法已经广泛应用于临床〔１～４〕，最佳手术方案的设计至关重要，它不但关系到手术的外形及效果，也关系到手术的成败。我院自１９７１年９月～１９９６年４月共施行足趾移植术４６４例５１１指，成活率１００％，现就本手术的设计问题进行探...     

足趾移植再造拇手指失败病例分析

1966年杨东岳等首创择期移植第二足趾再造拇指，十多年后顾玉东第二套供血系统理论的提出，使第二趾移植的成功率大为提高。四十年来这一手术已被手外科临床医生广泛采用，并作了不少改进和发展。如1984年程国良等L20开创了急诊足趾移植手术，报道13例（14指）急诊足跬移植再造拇、手指手术；1995年寿奎水等从临床实践中总结了亚急诊修复和再造拇、手指，认为术后疗效良好，方法切实可行。     

不同形式的足趾组织移植再造与修复

自1979年以来,我中心对1421例1649拇手指不同程度缺损者,选用不同形式的足趾组织移植进行再造与修复,成功1626指,失败23指,成功率达98.6%,获得满意的外形与功能。现就26年来对拇手指不同程度缺损选用不同形式足趾组织移植的再造与修复作一回顾性讨论。1拇指缺损的再造1.1Ⅰ°缺     

无足背动脉足趾移植再造拇手指方法的探讨

自1966年杨东岳等首创游离第2足趾移植再造拇指获得成功以来,已经广泛应用于各种拇手指缺损的再造,但是第1跖骨背动脉的变异仍是导致手术失败的重要因素,因此对第1跖骨背动脉的解剖变异及其处理方法进行了探入细致的研究,找到了一些行之有效的处理方法。但遇足背动脉缺损时,如何进行处理方能获得移植足趾的成活,仍是在研究的问题,趾动脉吻合再造拇手指是方法之一。作者自1977年9月～1966年4月共行(足母)甲瓣及足趾移植再造拇指464例,成活率100％,其中足背动脉缺损18例(3.8％),本文对无足背动脉足趾移植再造拇手指的方法进行探讨如下:     

足趾移植拇手指再造500例报告

自1979年以来,全军显微外科中心利用第2足趾,（足 母）趾甲瓣,第2、3趾,带足背皮瓣的第2趾或（足 母）甲瓣,足趾加游离皮瓣的组合组织移植等多种形式对拇手指缺损进行再造500例576指,成功572指,失败4指,成功率99．3％,现报道如下。     

我国足趾移植拇手指再造与修复回顾与展望

手是劳动器官，也是感觉器官，是人们生产劳动、日常生活、文化娱乐不可缺少的重要器官。拇指是手唯一能和其他四指作对捏的手指，拇指占手功能的40％。因此，拇指的缺失，将丧失手的近二分之一功能；同样若拇指完好其他四指缺失，也将丧失手功能的60％；若拇手指同时缺失，必将丧失该手大部或全部功能。因此，拇手指缺失实施再造是摆在手外科医师面前一个重要而现实的课题。随着医学的发展，1898年，Nieoladoni曾用蹿趾带蒂移植分期实施再造拇指，功能不理想。随后采用拇指残端提升、虎口加深拇指延长、示指或其他残指转位拇化、皮管植骨、掌骨拇化、拇指植骨交臂皮瓣及手部各种带血管神经蒂皮瓣转位等方法实施再造，恢复了拇指部分功能。     

学龄期儿童足趾移植再造拇、手指的体会

我院于1999年5月-2003年9月，行学龄期儿童足趾移植再造拇手指术15例，现结合学龄期儿童的生理特点将临床体会报告如下。     

利用自体废弃足趾移植急诊拇手指再造二例报道

对下肢毁损离断同时伴拇、手指毁损者 ,急诊一期用废弃自体足趾移植再造缺损的拇手指已获得成功。 2 0 0 0年度 ,我院手外科中心为 2例下肢毁损离断同时伴拇、手指毁损者 ,利用其完整的足部再造了拇手指 ,获得了比较满意的功能。　　例 1　男 ,1 7岁。 2 0 0 0年 2月 1 7日因印刷机绞伤致左小腿毁损性离断 ,右拇指及鱼际部毁损 ,伤后 4ｈ入院。入院后经抗休克治疗、生命体征平稳后行急诊手术。手术分 2组 :(1 ) 1组行左小腿截肢术。 (2 ) 1组再造拇指。左足右手彻底清创后 ,作离体游离趾移植再造拇指及修复大鱼际皮肤缺损术。右手第一掌骨…     

第二趾移植再造拇指的历史回顾与展望

1．病情介绍：患者男性，20岁，机床厂车工。一年前因工伤事故，左手丧失5个手指，仅存部分第一掌骨与第五掌骨。     

Delayed sensory reeducation after toe-to-hand transfer

The effect of a delayed program of sensory rehabilitation was evaluated in 13 patients with a total of 22 toe-to-hand transfers. Each patient was begun on a protocol of sensory reeducation at a mean of 38 months (range 13–98 months) after the transfer. Home rehabilitation, employing a Disk-Criminator (TM) program, was monitored at monthly intervals by the therapist for a mean of 3.3 months, at which time a final evaluation of sensibility was done. Each of the 22 toe transfers improved by an average of 7 mm in static and 6 mm in moving two-point discrimination. The improvement in two-point discrimination following delayed implementation of sensory reeducation was statistically significant at the P<0.0001 level. © 1995 Wiley-Liss, Inc.     

Thumb and finger reconstruction by toe-to-hand transfer.

Toe transplantation provides a means of restoring a thumb or finger in a single microsurgical procedure with tissues anatomically similar to those lost or absent. Although formidable, these toe transplantation procedures can be accomplished by experienced teams of microsurgeons with a high rate of success.     

足趾移植再造拇手指顽固性动脉痉挛的处理体会

目的 介绍足趾移植再造拇、手指术中和术后发生顽固性动脉痉挛的处理方法。方法 对19例拇手指缺损的患者，应用游离第二足趾移植再造拇手指术，其中10例在足趾游离后血管断蒂前发生动脉顽固性痉挛，术中仍按常规处理方法进行血管断蒂，拇、手指再造术。9例发生在第二足趾移植再造拇、手指血管吻合通血后至术后83h出现动脉顽固性痉挛而行手术探查，术中将痉挛段动脉切除，取前臂浅静脉作移植。结果 术后按显微外科常规方法处理，19例再造拇、手指全部获得成活。结论 对拇、手指再造术中和术后出现的顽固性动脉痉挛，采用即时性断蒂或静脉移植桥接动脉的方法是可行、有效的。     

足趾移植多手指再造相关问题的探讨

目的 研究多个手指缺损应用足趾移植再造的相关技术,以提高其疗效.方法 从1980年1月至2010年2月,我院进行足趾移植拇手指再造共计1 597例1 974指,对其中2指以上的多指再造354例731指进行了系统的回顾性分析.从手术适应证的掌握、手术方法及术后功能恢复等方面寻找规律,总结经验.结果 术后731指存活725指,失败6指,成活率为99%.29例术后发生血管危象,进行了再次手术探查.35例获得6个月至11年的随访,均恢复了较好的外形和手功能,胜任各种工作,患者满意.结论 多手指的缺损对患手功能和外观影响较大,要根据患手条件、患者年龄和本人意愿,选择合适的再造方案,最大限度地为患者再造一个接近正常的手.

Abstract：

Objective To study the relevant techniques of multi-finger reconstruction by toe-to-hand transfer and discuss the approaches to achieve better results. Methods A systemic review of 1 597 cases (1 974 fingers) of finger reconstruction by toe-to-hand transfer done during the period of January 1980 to February 2010 in our hospital was carried out. Among these, 354 cases (731 fingers) underwent multi-finger reconstruction (more than two fingers). They were analyzed retrospectively in respects of surgical indication,surgical methods, and postoperative functional recovery in order to seek the patterns and sum up the experience.Results Of the 731 fingers, 725 transplants survived. Only 6 transplants were lost. The survival rate was 99%. Surgical exploration was carried out in 29 cases due to vascular crisis. There were 35 cases that were follow-up for 6 months to 11 years. The appearance and functions of the reconstructed fingers were satisfactory.The patients could return to their jobs and were satisfied with the outcome. Conclusion Multi-finger defect greatly affects the appearance and function of the hand. An appropriate surgical reconstruction strategy should be chosen based on the condition of the hand, patient' s age and demand to restore a near normal hand.     

Aesthetic reconstruction of long fingers with toe-to-hand transfer

This paper reports experiences of 67 toe-to-hand transfers. Success was achieved in all cases. Six cases are discussed that deal with the less investigated problem of long finger reconstruction. Amputation injuries of long fingers through the metacarpus are difficult problems. A determining principle of their restoration consists of the creation of adequate toe length for transfer and correction of biomechanic hyperextension. The report also highlights the advantages of metacarpal reconstruction with the "brass-knuckle" procedure, as the best technique for this type of injury. Aesthetic and functional advantages after such long finger reconstruction and psychological recovery of the patient seem worthy of emulation.     

Great toe-to-hand free tissue transfer for thumb reconstruction

Based upon our experience at the Massachusetts General Hospital, where 32 microneurovascular toe-to-hand transfers have been performed over the past eight years, this method of thumb reconstruction can be quite successful in carefully selected and educated patients.     

The first toe-to-hand transfer: a thirty-year follow-up

In April 1968 the first successful free toe-to-hand transfer was performed by Mr. J. R. Cobbett at the Queen Victoria Hospital to reconstruct the thumb of a woodworker. Details of the case are discussed and the patient's current level of sensation, power and function are presented over 30 years following reconstruction.     

亚太地区断指再植、手指再造与异体手移植治疗进展

第5届亚太地区手外科学术大会,有关断指再植、拇手指再造与手移植专题论文交流30篇。异体手移植临床研究,中国广州南方医院开展了3例4肢;基础研究,中国与日本学者研究了移植供体细胞转化,CTLA4Ig、肿瘤坏死因子、供体骨髓细胞受体骨髓内注射的抗免疫排斥作用。马来西亚Selayand医院进行1例新生儿同卵双胞胎之间异体上肢移植术,功能恢复良好。指尖离断再植、急诊拇指缺失再造、指甲缺失的显微外科移植再造,技术要求高,成活率高,功能恢复效果好,值得推广应用。