足趾移植再造拇指及手指541例

１９７７年～１９９６年共行足趾移植再造拇指及手指５４１例（６５４指），其中再造拇指４０４例，手指７８例（１２２指），拇指及手指同时再造５９例（１２８指）。拇指再造方式为：拇指Ⅰ、Ⅱ度缺损足趾移植４２例，口止母趾甲皮瓣加髂骨块移植１６例，Ⅲ、Ⅳ度缺损行口止母趾甲皮瓣与第二趾骨关节肌腱血管神经联合移植３４例，第二跖趾关节以远移植１８２例，Ⅴ、Ⅵ度缺损行携带跖趾关节的第二趾移植１８９例。手指再造为：手指Ⅱ、Ⅲ度缺损行趾与指吻合血管移植再造２９例，Ⅳ、Ⅴ度缺损再造８１例，Ⅵ度缺损再造２７例（共１９１指）。发现血管变异１０４例（１９．２％），其中足背动脉１９例，大隐静脉１３例，第一跖背动脉７２例。术后再造的拇指手指全部成活。对术前手术方案设计，手术要点，尤其是对血管变异的处理提出了行之有效的方法。

THUMB AND FINGER RECONSTRUCTION WITH THE PEDAL DIGIT TRANSPLANTATION: 541 CASES REPORT

Thumb and finger reconstruction by the method of pedal digit transplantation had been successfully performed in 541 casee from 1977 to 1996, which contained 404 cases of thumbs and 78 cases of fingers. The thumb reconstruction was mainly the simple transplantation of distal phalanx (42 cases) and the compound transplantation of hallucal nail cutaneous flap with iliac bone segment (16 cases) for the defect of thumbs in degree 1 and 2. The combined transplantation of hallucal nail cutaneous flap with the joint and tendons of the second toe (34 cases) and the transplantation of the distal part of the second toe (182 cases) for the defect of degree 3 and 4. The combined transplantation of the second pedal digit with its metatarsalphalangeal joint (189 caese) for the defect in degree 5 and 6. The finger reconstruction was performed by anastomosis of the arteries of the digit with those of the fingers for 29 cases with the defect in degree 2 and 3, 60 cases with the defect in degree 4 and 5, and 17 cases with the defect in degree 6. One hundred and four cases of versels vasiation were found in this group (19 cases with the pedal dorsal artery, 13 cases with the greater saphenous vein and 72 cases with the first dorsal metatarsal artery). The main point of the operation and the treatment of the vessel varitations were discussed.