游离第二足趾移植再造拇、示指的临床应用及疗效分析

目的:探讨游离第二足趾移植再造拇、示指手术方法和临床疗效。方法:游离第二足趾移植再造拇、示指共5例,男3例,女2例,年龄16~41岁,平均28.5±3.4岁。拇指2例,示指3例。急诊手术3例(2例拇指、1例示指,受伤致手术时间均6h内),二期手术2例(2例示指,分别急诊处理术后21d、24d进行手术)。本组病例据顾玉东等再造手指缺损分度:拇指为Ⅲ度、Ⅳ度各1例,示指为Ⅳ度1例、Ⅴ度2例。结果:本组5例中均未发生血管危象,全部病例顺利成活。平均住院时间19±3.5d,术后随访9～18个月,平均12.5±2.0个月。再造指痛温觉恢复良好,两点辨别5～10mm,再造指间关节屈曲10°～30°,掌指关节屈曲35°～80°。4例对掌指功能良好,1例对掌指功能欠佳。根据中华医学会手外科学会上肢部分功能评定试用标准评定,优良率80%。5例患者均于术后2～4月恢复正常的行走、负重功能。结论:第二足趾外形和组织结构与手指相近,大小与手的血管、神经相当,可供吻合,术后对供足的影响不大,最大限度地恢复了伤手的外观及功能,值得临床推广开展的手术。

Clinical application and efficacy analysis of reconstructing thumb and forefinger by the free second toe

Objective: To explore the clinical effect of reconstructing thumb and forefinger by free second toe.Methods: 5 patients with thumb and forefinger wound were treated by second toe transplantation,male 3 and female 2,average age of 28.5±3.4 yeas(16~41 yeas).2 cases of thumb,3 cases of forefinger.3 cases(2 cases of thumb and 1 case of forefinger) were treated by emergency operation,2 cases of forefinger were treated by selective operation.According to deficiency gradation of finger,there were 2 cases of grade Ⅲ and Ⅳ in thumb,1 case of grade Ⅳ and 2 cases of grade Ⅴ in forefinger.Results: All reconstructed thumbs and forefingers were alive,vascular crisis were not found.5 patients were followed up 9 to 18 months with an average of 12.5±2.0 months.The sense of pain and temperature of replantated fingers were very good,and the two point discrimination of finger were 5mm to 10mm.The flexion range was 10 to 30 degree in reconstructed interphalangeal joint,and 35 to 80 degree in metacarpophalangeal joint.4 cases were good and 1 case was bad in the opposition function.According to functional tentative evaluation criteria of hand surgery in upper extremity by Chinese Medical Association,the rate of excellency and goodness was 80%.All patients recovered normal walking function after operation.Conclusion:The shape and organizational structure of thumb-forefinger are resemble to second toe,and are convenient on anastomosis.The function and shape of fingers are recovered with minor destructions of donor foot.It is worthy of clinical application.